A retinal hemorrhage is a potential complication of fetal and neonatal alloimmune thrombocytopenia (FNAIT), a rare immune disorder characterized by abnormally low platelet counts, also known as thrombocytopenia.
Because platelets play a pivotal role in sealing up blood vessel injury, FNAIT can lead to easy bleeding, including in the eyes. Fortunately, many cases of retinal hemorrhage in newborns clear up on their own, but severe cases can require medical treatment.
Here’s a closer look at why retinal hemorrhages occur with FNAIT, the effects and how they’re managed.
Why retinal hemorrhage can occur in FNAIT
FNAIT is the most common cause of newborn thrombocytopenia and occurs in an estimated one in 1,500 pregnancies. It happens when the mother’s immune system identifies the baby’s platelets as foreign and develops antibodies to destroy them.
This immune response can arise when the mother’s blood comes in contact with the baby’s, either during fetal development or during delivery. A mother’s immune cells may have this response when the baby’s platelets contain an antigen from the child’s father that the mother doesn’t have.
Many babies with FNAIT have only mild symptoms, such as bleeding under the skin, which can lead to patches of discoloration on the skin. Some babies have no symptoms at all.
Learn more about FNAIT prognosis
But severe cases of FNAIT can lead to bleeding in major organs like the brain, gastrointestinal tract and eyes.
Retinal hemorrhage is the medical term for bleeding within the retina, the light-sensitive tissue at the back of the eye. It occurs following a rupture or leak in the blood vessels in the retina, causing blood to spill out.
A baby’s birth itself can add extra stress on blood vessels in the eye, particularly when there’s trauma during delivery. In fact, retinal hemorrhage occurs in about a quarter of all normal vaginal births, with higher rates when instruments like forceps or a vacuum are involved. A low platelet count from FNAIT can make these bleeds more likely to occur.
While not as commonly reported as bleeding in other organs like the brain or GI tract, a recent study suggests retinal hemorrhage may be an underrecognized consequence of FNAIT.
Effects of retinal hemorrhages
In many cases, retinal hemorrhages in newborns with FNAIT are mild and resolve on their own within a couple of weeks without lasting effects.
However, severe cases may last for a longer period of time and potentially cause vision loss. In these cases, your doctor might recommend a follow up with a pediatric ophthalmologist. Treatment options can include laser or cryotherapy, medication injected into the eye or surgery.
Platelet transfusions administered before birth if the diagnosis was made prenatally or soon after delivery can also help restore clotting capacity and reduce the risk of ongoing bleeding.
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