Medical Archive

C124.1 Anemia in the Newborn Infant

# Low reticulocyte

# Anemia of prematurity

• Etiology
  • Impaired EPO production
  • Short RBC life span (40-50 days)
  • Iatrogenic blood sampling (frequent phlebotomy in the NICU)
• Clinical manifestations
  • Usually asymptomatic
  • Tachycardia, apnea, poor weight gain
• Lab findings
  • Low Hb, Hct, reticulocyte count
  • Normocytic, normochromic RBCs
• Treatment
  • Minimize blood draws
  • Iron supplementation
  • Transfusion

C124.2 Hemolytic Disease of the Newborn (Erythroblastosis Fetalis)

Hemolytic disease of the newborn caused by Rh incompatibility

Rh (-) mothers; Rh (+) fetus
Jaundice shortly after birth, kernicterus, hydrops fetalis
Prevent by administration of anti-D IgG to Rh (-) pregnant women during 3^rd trimester and early postpartum period

Hemolytic disease of the newborn caused by blood group A and B incompatibility

Q. ? Rh incompatibility?? ??? ?????
A. A/B antigen? ?? fetal tissue?? ???? ??? ????? ????.

• Type O mothers; type A or B fetus
  • Mostly have IgG – cross the placenta
  • Mild jaundice in the neonate within 24hours of birth.
  • Treat newborn with phototherapy or exchange transfusion
• Type A or B mothers
  • Mostly have IgM – can’t cross the placenta

Other forms of hemolytic disease

C124.3 Plethora in the Newborn Infant (Polycythemia)

Hematocrit >65% in term infants (normal: 42%-65%)

Pathogenesis

• Increased erythropoiesis from intrauterine hypoxia
  • Maternal diabetes, hypertension, or smoking
  • IUGR
• Erythrocyte transfusion
  • Delayed cord clamping
  • Twin-twin transfusion
• Genetic/metabolic disease
  • Hypothyroidism or hyperthyroidism
  • Genetic trisomy (13, 18, 21)

Clinical presentation

• Asymptomatic (m/c)
• Ruddy skin, hyperbilirubinemia, abdominal distension
• ?Viscosity may cause ?blood flow to organs
  • Lethargy, irritability, jitteriness
  • Respiratory distress, cyanosis, apnea
• ?Cellular uptake
  • Hypoglycemia, hypocalcemia

Treatment

• IV fluids
• Glucose
• Partial exchange transfusion

C124.4 Hemorrhage in the Newborn Infant

Vitamin K deficiency bleeding

• Classic VKDB
  • Presents in the first week of life with easy bruising and mucosal and GI bleeding
• Late-onset VKDB
  • Between age 2 weeks and 6 months
  • More commonly associated with intracranial hemorrhage

Disseminated intravascular coagulopathy

Neonatal thrombocytopenia

See chapter 511.