Thomas Jefferson University, Philadelphia, PA, USA.
Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA.
Child Abuse Negl. 2021 Feb;112:104901. doi: 10.1016/j.chiabu.2020.104901. Epub 2021 Jan 2.
Retinal hemorrhages (RH) are a common manifestation of abusive head trauma (AHT) resulting from acceleration-deceleration injury with or without blunt impact. Evaluation of a child with RH requires careful consideration of these differential diagnoses. The extent to which coagulopathy alone can cause RH would be useful to understand as coagulopathy may accompany AHT.
In this systematic review, we sought to identify whether coagulopathies have been reported with RH similar to those of AHT.
We performed a literature search for ocular manifestations of bleeding disorders in children less than 18 years old. We included clotting factor deficiencies, vitamin K deficiency, platelet function abnormalities, thrombocytopenia, disseminated intravascular coagulation (DIC), and trauma induced coagulopathy (TIC). We included only pediatric reports of intraocular bleeding or documented eye examinations that indicated no hemorrhages. We then re-examined cases for ocular and systemic findings that could potentially mimic abuse.
Our initial search yielded 816 results. Sixty-one articles met our inclusion criteria. Of these, there were 32 children within the AHT age range (less than 5 years old) who had RH and concomitant coagulopathy. Only 5 cases might potentially be confused for abuse. Of these, no classic characteristics of RH from abuse such as retinoschisis or retinal folds were found. Systemic features were inconsistent with AHT.
The presence of coagulopathy alone does not rule out the possibility that the child has been abused. Coagulopathy alone has not been reported as an etiology of RH that are consistent with AHT, especially when other findings are present.
视网膜出血（RH）是加速-减速损伤引起的虐待性头部外伤（AHT）的常见表现，伴有或不伴有钝性冲击。评估有 RH 的儿童需要仔细考虑这些鉴别诊断。了解单纯凝血功能障碍是否会导致 RH 很有帮助，因为凝血功能障碍可能伴随 AHT。
在本系统评价中，我们试图确定是否有报道称凝血功能障碍与 AHT 相似的 RH 有关。
我们对 18 岁以下儿童出血性疾病的眼部表现进行了文献检索。我们纳入了凝血因子缺乏、维生素 K 缺乏、血小板功能异常、血小板减少症、弥漫性血管内凝血（DIC）和创伤诱导性凝血障碍（TIC）。我们只纳入了儿童眼内出血的报告或有记录的眼部检查表明无出血的病例。然后，我们重新检查了可能模拟虐待的眼部和全身表现。
我们最初的搜索产生了 816 个结果。有 61 篇文章符合我们的纳入标准。其中，有 32 名儿童年龄在 AHT 范围内（小于 5 岁），有 RH 和同时存在凝血功能障碍。仅有 5 例可能存在潜在的虐待。在这些病例中，没有发现与虐待相关的 RH 的典型特征，如视网膜劈裂或视网膜褶皱。全身特征与 AHT 不一致。
单纯存在凝血功能障碍并不能排除儿童受到虐待的可能性。单纯凝血功能障碍尚未被报道为与 AHT 一致的 RH 的病因，尤其是当存在其他发现时。
