Anemia in the Newborn Infant
Dr.nawal 4.12.2014 thu
Hb increases with advancing GA.
at term, cord blood Hb (14–20 g/dL).
physiological anemia decrease in Hb
at 8–12 wk in term infants (Hb, 11 g/dL).
at 6 wk in premature infants (7–10 g/dL)
Anemia at birth is manifested as pallor, heart failure, or shock
causes
-fetal blood loss (acute, chronic): p.p or abruption.
twin-twin transfusion in monozygotic twin.
Tearing,cutting of the umbilical cord during delivery.
internal hemorrhage (liver, spleen, intracranial).
hemorrhagic disease of the newborn.
-Hemolysis: hemolytic disease of the newborn.
-underproduction of RBC: α-thalassemia, congenital parvovirus infection.-
Acute blood loss: severe distress at birth, initially with a normal hemoglobin
level or shock.
-chronic blood loss in utero produces marked pallor, a low hemoglobin level
with microcytic indices,
if severe, heart failure.
Anemia of prematurity
-occurs in low birthweight infants 1–3 mo after birth.
-hemoglobin levels below 7–10 g/dL.
-pallor, poor weight gain, decreased activity, tachypnea, tachycardia, and
feeding problems.
-Repeated phlebotomy, shortened RBC survival, rapid growth, and the
physiologic effects of the transition from fetal to neonatal life contribute to
anemia of prematurity.
Treatment
1-blood transfusion :-
depends on the severity of symptoms, the hemoglobin level, and the
presence of co-morbid diseases
-Packed RBC transfusion (10–20 mL/kg) rate of 2–3 mL/kg/hr.
2 mL/kg raises the hemoglobin level 0.5–1 g/dL.
-Hemorrhage should be treated with whole blood .
2-Recombinant human erythropoietin (r-HuEPO) :
Anemia of prematurity ( low endogenous levels of serum erythropoietin)
Therapy with r-HuEPO must be supplemented with oral iron and possibly
vitamin E.
HEMORRHAGIC DISEASE OF THE NEWBORN
.
-A moderate decrease in factors II, VII, IX, and X normally occurs in all
newborn infants by 48–72 hr after birth.
-gradual return to birth levels by 7–10 days of age.
transient deficiency of vitamin K–dependent factors :
-lack of free vitamin K from the mother.
-absence of the bacterial intestinal flora.
Rarely, in term infants and more frequently in premature infants,
accentuation and prolongation of this deficiency between the 2nd and 7th
days of life result in spontaneous and prolonged bleeding.
Breast milk is a poor source of vitamin K..
classification
1-EARLY ONSET
2-CLASSIC DISEASE
3-LATE ONSET
bleeding is gastrointestinal, nasal, subgaleal, intracranial, or
postcircumcision.
The prothrombin time (PT), blood coagulation time, and PTT are prolonged,
and levels of prothrombin (II) and factors VII, IX, and X are significantly
decreased.
Prevention : Intramuscular administration of 1 mg of vitamin K at the time
of birth .
Treatment
a slow intravenous infusion of 1–5 mg of vitamin K1, response within a few
hours.
-Serious bleeding, (premature infants or those with liver disease), may
require a transfusion of fresh frozen plasma or whole blood).
Differential diagnosis
-congenital defects in blood coagulation .
-Disseminated intravascular coagulopathy in newborn
-swallowed blood syndrome:
-subcutaneous ecchymoses in premature infants ( fragile superficial blood
vessels)
APT TEST
1-Rinse a blood-stained diaper or some grossly bloody (red) stool with a
suitable amount of water to obtain a distinctly pink supernatant hemoglobin
solution.
2- Centrifuge the mixture and decant the supernatant solution.
3-To five parts of the supernatant fluid add one part of 0.25 N (1%) sodium
hydroxide. Within 1–2 min a color reaction takes place: A yellow-brown
color indicates that the blood is maternal in origin; a persistent pink indicates
that it is from the infant.
Diaa abdulfatah