Blood in Tears

Dear Lisa,

My niece is 15 days old. We found that she is crying with blood. We were told that this could be an incompatibility of the Rh factor with the mother. When we had a second opinion, she was diagnosed with immature tear duct. We are afraid coz when she cries a lot she forms blood as tears. What is the real condition my niece has?

“Blood in tears”

Dear “Blood in tears”,

It is not normal for a baby to cry tears with blood in them. Children with a blocked tear duct have an increase in the amount of tears and mucus discharge. (1) The tears tend to be cloudy or sticky, but they should not be bloody. Any baby with bleeding should be evaluated for a bleeding disorder such as Hemophilia, von Willebrand Disease, a platelet defect, or other blood disorder. (2) A complete history and physical examination along with testing is necessary in order to come up with an accurate diagnosis. Usually when bleeding is found in a baby, other sources of bleeding are also investigated. It is common to also test the baby’s urine and stool for the presence of blood. In addition bloodwork is typically drawn in order to evaluate blood clotting factors, to rule out anemia and check the baby’s ability to make blood cells. In some cases an ultrasound of the brain and abdomen are needed in order make a diagnosis. (3)

Typical signs of a bleeding disorder include prolonged bleeding from a needle stick (from childhood immunizations or blood test), prolonged bleeding from a laceration, cuts in the mouth that wont heal, frequent nosebleeds, large bruises after a trauma, many bruises (black and blue marks)on the body, prolonged bleeding from the circumcision site (which does not apply to your niece because she is female) and excessive bleeding after dental work in an older child. (2) Prolonged or unusual bleeding in any child needs to be addressed because it can lead to anemia and have serious consequences.

Rh factor incompatibility can cause serious hemolytic or bleeding problems in the newborn (4) “Rh factor” occurs when the mother’s blood type is different from her baby’s. If an Rh positive baby is born to an Rh negative mother, the mother’s body identifies the baby’s blood as foreign. As a result the mother’s body makes antibodies which attack the baby’s blood. This process occurs when the mother’s body is exposed to the baby’s blood, such as during birth, during an abortion or from an ectopic pregnancy. (4) Typically the mother’s sensitization takes some time and this condition is usually not a concern with a first pregnancy. Although, it is possible to occur during a first pregnancy if the mother had a blood transfusion, an amniocentesis or a condition called placenta abruptio. (4) Rh incompatibility and its complications are more of a concern in a second pregnancy and the pregnancies that follow. (3)

Rh factor incompatibility is a serious problem that is typically addressed while the mother is pregnant and when a baby is delivered. For mothers who receive prenatal care, the risk of Rh incompatibility is determined by the Obstetrician. If a mother is at risk, RhoGam, an immunization to prevent this problem is given to the mother in order to reduce the risk to future pregnancies. (4). Since the initiation of this vaccine in the 1960’s the incidence of complications from Rh factor incompatibility has been drastically reduced. (4)

For babies born in a hospital, Rh factor incompatibility can be identified at birth or shortly after birth due to findings on the physical examination and laboratory testing of the infant. The symptoms include a large placenta, jaundice at birth, jaundice that occurs within the first 24 hours after birth or in milder cases jaundice that develops later. (3,4) Early identification and treatment of the baby’s jaundice or hyperbilirubinemia (build up of broken down red blood cells in the baby’ body) results in a better outcome. If a baby is discovered to have severe complications of Rh factor incompatibility after birth, a special type of blood transfusion called an exchange transfusion can be given to the infant in order to save the baby’s life. (4)

Since your niece’s parents do not seem to know the cause of their daughter’s bleeding, they may benefit from the expertise of a Pediatric Hematologist. A Pediatric Hematologist specializes in blood abnormalities and the diagnosis and treatment of childhood bleeding disorders. An evaluation by a Pediatric Hematologist should shed some light on your niece’s situation.

(1)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 650.
(2)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990: 456-463.
(3)Behrman R, Kliegman R. Nelson Essentials of Pediatrics. Philadelphia, PA: W.B. Saunders Company. 1990:183-185.
(4)Jensen M, Bobak I. Maternity and Gynecologic Care. 3rd ed. St. Louis Missouri: The C.V. Mosby Co. 1985:1125.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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