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Beken S. et al: Intrauterine Arterial IschemiaIMAGES IN HEMATOLOGYDOI: 10.4274/tjh.galenos.2020.2020.0530Turk J Hematol 2021;38:222-223Extremity Necrosis Due to Intrauterine Arterial Ischemiaİntrauterin Arteriyel İskemiye Bağlı Gelişen Ekstremite NekrozuSerdar Beken 1 , Kerim Sarıyılmaz 2 , Eda Albayrak 3 , Arzu Akçay 4 , Ayşe Korkmaz 11Acıbadem University Faculty of Medicine, Department of Pediatrics, Neonatology Subdivision, İstanbul, Turkey2Acıbadem University Faculty of Medicine, Department of Orthopedics, İstanbul, Turkey3Acıbadem University Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey4Acıbadem University Faculty of Medicine, Department of Pediatrics, Pediatric Hematology Subdivision, İstanbul, TurkeyFigure 1. (a-d) Left lower extremity was rudimentary, pale, shorter thanthe right, and had a club-foot deformity. The demarcation line becameclear on the 5 th day and amputation was performed under the left hipjoint.©Copyright 2021 by Turkish Society of HematologyTurkish Journal of Hematology, Published by Galenos Publishing HouseAddress for Correspondence/Yazışma Adresi: Serdar Beken, M.D., Acıbadem University Faculty of Medicine,Department of Pediatrics, Neonatology Subdivision, İstanbul, TurkeyPhone : +90 532 671 31 96E-mail : serbeken@gmail.com ORCID: orcid.org/0000-0002-8609-2684Received/Geliş tarihi: September 1, 2020Accepted/Kabul tarihi: October 13, 2020222
Turk J Hematol 2021;38:222-223Beken S. et al: Intrauterine Arterial IschemiaA preterm male infant weighing 1230 g was delivered by cesareansection at 32 1/7 gestational weeks. His twin weighed 1300 g andneither required resuscitation. On physical examination, the leftlower extremity was rudimentary, pale, shorter than the right,and had a club-foot deformity. Computerized tomographicangiography demonstrated a bluntly filled femoral artery withno distal passage. During follow-up, the demarcation linebecame clear on the 5 th day and amputation was performedunder the left hip joint (Figure 1).Laboratory tests including homocysteine, folate, prothrombintime, activated partial thromboplastin time, protein C and Sactivity, fibrinogen, and antithrombin III activity were withinnormal limits according to gestational age, except for highD-dimer (4.13 mg/dL). Antiphospholipid and anticardiolipinantibodies were also negative. The patient was found to behomozygous for methylenetetrahydrofolate reductase C677T;thrombosis was not observed in histopathological examination.The patient was successfully discharged from the hospital onthe 40 th day of life.Arterial ischemia of the limb can be seen after thromboembolicevents or vascular interventions [1,2]. Ischemic changes presentat birth suggested intrauterine onset causes that might beattributable to occlusive vascular disruption [3]. Diminishedblood flow altered normal soft tissue and osseous growth andresulted in ischemia in fetal life, ending with limb loss.Keywords: Newborn, Ischemia, ArterialAnahtar Sözcükler: Yenidoğan, İskemi, ArteriyelInformed Consent: It was received.Authorship ContributionsSurgical and Medical Practices: S.B., K.S., E.A, A.A., A.K.; LiteratureSearch: S.B., K.S., E.A, A.A., A.K.; Writing: S.B., K.S., A.K.Conflict of Interest: No conflict of interest was declared by theauthors.Financial Disclosure: The authors declared that this studyreceived no financial support.References1. Wang SK, Lemmon GW, Drucker NA, Motaganahalli RL, Dalsing MC, GutweinAR, Gray BW, Murphy MP. Results of nonoperative management of acutelimb ischemia in infants. J Vasc Surg 2018;67:1480-1483.2. Bekmez S, Beken S, Dinç T, Dursun A, Zenciroğlu A, Dilli D, Okumuş N. Lowerextremity amputation in a preterm infant due to MTHFR homozygosity.Genet Couns 2014;25:245-249.3. Turnpenny PD, Stahl S, Bowers D, Bingham P. Peripheral ischemia andgangrene presenting at birth. Eur J Pediatr 1992;151:550-554.223
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