title: Severe bleeding complications other than intracranial hemorrhage in neonatal alloimmune thrombocytopenia: a case series and review of the literature.
abstract: The most feared bleeding complication in fetal and neonatal alloimmune thrombocytopenia (FNAIT) is an intracranial hemorrhage (ICH). However, FNAIT may also lead to other severe bleeding problems. The aim was to analyze this spectrum and evaluate the occurrence of severe hemorrhages other than ICH in fetuses or neonates with FNAIT.
  
  
  
  A retrospective chart analysis of cases of FNAIT presenting with severe bleeding complications other than ICH at our institution from 1990 to 2015 was conducted. Additionally, a review of the literature was performed to identify case reports and case series on FNAIT presenting with extracranial hemorrhage.
  
  
  
  Of 25 fetuses or neonates with severe bleeding due to FNAIT, three had isolated severe internal organ hemorrhage other than ICH, two pulmonary hemorrhages and one gastrointestinal hemorrhage. Two of these three neonates died due to this bleeding. Eighteen cases of extracranial bleeding complications as a first presentation of FNAIT were found in the literature, including ocular, gastrointestinal, spinal cord, pulmonary, renal, subgaleal, and genitourinary hemorrhages.
  
  
  
  Bleeding complications other than ICH may be more extensive, and the presentation of FNAIT may have a greater spectrum than previously described. A high index of suspicion on the possible diagnosis of FNAIT with any bleeding complication in a fetus or neonate may enable adequate diagnostics, adequate treatment, and appropriate follow-up in future pregnancies, as is especially relevant for FNAIT.
authors.affiliation: Department of Obstetrics, Leiden University Medical Center.
authors.forename: Dian
authors.initials: D
authors.lastname: Winkelhorst
authors.affiliation: Department of Obstetrics, Leiden University Medical Center.
authors.forename: Marije M
authors.initials: MM
authors.lastname: Kamphuis
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center.
authors.forename: Liselotte C
authors.initials: LC
authors.lastname: de Kloet
authors.affiliation: Jon J. Van Rood Center for Clinical Transfusion Research, Sanquin Blood Supply Foundation.|Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jaap Jan
authors.initials: JJ
authors.lastname: Zwaginga
authors.affiliation: Department of Obstetrics, Leiden University Medical Center.
authors.forename: Dick
authors.initials: D
authors.lastname: Oepkes
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center.
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D000328:Adult; D005260:Female; D005315:Fetal Diseases; D006470:Hemorrhage / Q000209:etiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011247:Pregnancy; D012189:Retrospective Studies; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000453:epidemiology / Q000473:pathology*