Introduction: The preleukaemic and leukaemic diseases of infant and early childhood have been described. CL is a rare haematologic disease most often diagnosed at birth or within the first month of life and commonly are of acute myeloid leukaemias (AML). This however need to be differentiated from TAM of the newborn. We present a case and highlight challenges encountered in placental examination. Case report: A 35-year-old lady, in her fifth pregnancy presented at 40 weeks of gestation with absence in fetal movement. Further investigation confirmed an intrauterine death. Following induction of labour a male macerated stillborn was delivered. It was observed that the umbilical cord was short and the right testis was undescended. There were no associated syndromic features seen. The parents did not consent to a postmortem examination. The placenta was pale, foul smelling with meconium stains. Microscopically, there were numerous circulating immature precursors and nucleated red blood cells within the fetal vessels in the umbilical cord and chorionic villi. The morphology and immunohistochemistry were suggestive of a megakaryoblastic lineage. Discussion: Both AML and TAM are known manifestations in neonates with Down’s syndrome, predominantly involving the megakaryoblastic series. Although clinically and haematologically indistinguishable, TAM is transient and usually exhibits a spontaneous regression. However, with heart and liver involvement TAM may cause fetal demise. The underlying genetic contributions were not established in this case. However, both entities along with other neonatal leukaemoid and leucoerythroblastic conditions need to be considered. Hence detailed placental examination with relevant immunohistochemistry analysis is recommended.

Introduction: Parvovirus B19 infection is a well-established cause of fetal death in hydrops fetalis. The diagnosis is usually made through histological identification of the characteristic nuclear inclusions in the placenta or fetal organs. However, the search for these inclusions are difficult at times particularly when placental sampling is limited or consent for fetal autopsy is not obtainable. We would like to share a case of congenital parvovirus infection with these characteristic inclusions and highlight the usefulness of immunohistochemistry. Case report: A 30-year-old lady, in her fourth pregnancy was referred for hydrops fetalis at 21 weeks gestation. She has three living children whom are currently well. Following induction of labour she delivered a male fetus. There were no dysmorphic features observed. However, the placenta was markedly large for gestational age, pale and friable with low fetoplacental ratio. On histology there were hydropic villi with increased nucleated red blood cells (RBC) within chorionic fetal vessels, many of which contained the characteristic intranuclear inclusions. They stained positively on immunostaining with parvovirus antibody. The parvovirus serology at the time of presentation was equivocal for IgM and positive for IgG. Other relevant microbiological investigations were negative. Discussion: Parvovirus infection is one of the commonly occurring intrauterine infections. Recognizing the histopathological features may aid in identifying the cause of intrauterine death as many of these women are asymptomatic. The use of immunostaining is very useful in confirming viral inclusions in the nucleated RBC and usually reveals a larger number of positive cells compared to H&E staining alone.