Two neonates with erythroblastosis fetalis developed significant hemorrhage from splenic tears. Each infant had received several exchange transfusions with heparinized blood before developing marked abdominal distention, a rapidly falling hematocrit reading, and signs of cardiovascular collapse. Paracentesis in each case confirmed the presence of intra-abdominal bleeding and preoperative coagulation studies revealed decreased levels of multiple clotting factors and platelets. The underlying hemostatic abnormality in each infant was further complicated by our failure to neutralize the heparin used in the exchange transfusions. Both infants were successfully treated by preoperative replacement of specific clotting factors and a conservative surgical approach not requiring splenectomy.
Simmons MA, Burrington JD, Wayne ER, Hathaway WE. Splenic Rupture in Neonates With Erythroblastosis Fetalis. Am J Dis Child. 1973;126(5):679-681. doi:10.1001/archpedi.1973.02110190547018