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Bilateral vitreous hemorrhages in an infant with low fibrinogen levels
W E Marshman1, G G Adams, R Ohri
1Strabismus and Paediatric Service, Moorfields Eye Hospital, London, United Kingdom.
Insights
A rare blood clotting disorder, low plasma fibrinogen, caused severe retinal and vitreous hemorrhages in an infant. This finding challenges the assumption of nonaccidental injury in such cases.
Area of Science:
- Ophthalmology
- Hematology
- Pediatrics
Background:
- Retinal and vitreous hemorrhages in young children often raise concerns for nonaccidental injury.
- Blood dyscrasias are known causes of retinal hemorrhages, but rarely reported in neonates.
Observation:
- A case of a neonate presenting with bilateral retinal hemorrhages that progressed to vitreous hemorrhages.
- The infant had a documented low plasma fibrinogen level, indicating a subtle blood clotting abnormality.
Findings:
- The low plasma fibrinogen level was identified as the cause of the severe retinal and vitreous hemorrhages.
- The infant had no identifiable risk factors for abuse, highlighting an alternative etiology.
Implications:
- This case underscores the importance of considering hematological causes, such as fibrinogen deficiency, in neonates with retinal hemorrhages.
- Accurate diagnosis can prevent misinterpretation as nonaccidental injury, ensuring appropriate medical management and family support.
Abstract:
The finding of retinal or vitreous hemorrhage in a child under age 3 years may cause significant controversy with regard to the etiology, because it raises the suspicion of nonaccidental injury. Blood dyscrasias have been documented to cause retinal and vitreous hemorrhages in adults and children, but they have rarely been reported to be the cause of retinal hemorrhages in neonates. We report on a patient with a low plasma fibrinogen level who had bilateral retinal hemorrhage that proceeded to vitreous hemorrhage. This subtle abnormality of the blood clotting cascade caused significant retinal and vitreous hemorrhage in a child without risk factors for abuse.