Death During Blood Transfusion as a Result of Intracranial Hemorrhage

Abstract

Death from cerebral hemorrhage occurring a week or more after birth and due to an injury presumably sustained at birth is rare in infants who show no signs of cerebral hemorrhage at birth and who develop normally until death. Two such cases in the literature were reviewed in 1929 by Glaser,1 who added a third of his own. Since then, so far as we have been able to determine, no other cases of this nature have been reported. The one described, because of the rarity of the occurrence, and because of the lessons which may perhaps be drawn from it, is considered worthy of reporting in an attempt to add to the knowledge of this fortunately uncommon condition.The infant was first seen by the pediatric consultants at the age of 8 days. A ritual circumcision had been performed by an experienced mohel about six hours previously. Shortly afterward the infant started bleeding profusely and steadily from the site of the operation. Local measures, as well as the intramuscular injection of some of the mother's blood, proved ineffective in controlling the bleeding. Transfusion was deemed necessary as a life-saving measure. Both mother and child belonged to group 3 (Moss), and cross-matching by two physi¬ cians working independently showed the bloods to be compatible. The infant's red corpuscle count was 3,770,000 and his hemoglobin content 70 per cent Sahli.Transfusion was started through a vein in the scalp, the blood being given through a syringe 4 cc. at a time and very slowly because of the small size of the vein and of the needle used. In thirty-five minutes 54 cc. of blood and 20 cc. of physiologic solution of sodium chloride were given. There was the usual amount of struggling on the part of the child, but the procedure was going smoothly when he suddenly became cyanotic. Transfusion was immediately discontinued. Respirations ceased, and occasional cardiac sounds were heard only a moment or From the departments of pediatrics and obstetrics of the University of Rochester School of Medicine and Dentistry and the department of obstetrics of the Rochester General Hospital.