Anemia
Most common cause of anemia in preterm infants
What are frequent lab draws or iatrogenic?
This hematocrit level defines neonatal polycythemia by a specific kind of blood draw.
What is ≥65% in central venous blood?
A lab test that best differentiates an anemia caused by hemolysis versus acute hemorrhage?
What is the reticulocyte count?
Low retic count and low HcT -> Hemorrhage/ acute blood loss
High in retic count and low HcT -> hemolysis
The first line treatment for symptomatic polycythemia when hct >70%.
What is partial exchange transfusion?
A maternal condition that increases the risk of fetal anemia.
What are maternal alloimmunization, TORCH infections, and potentially placental abruption if severe and acute?
This standard procedure after birth may increase the risk for polycythemia in term infants.
What is delayed cord clamping?
This test is used for diagnosing fetal-maternal hemorrhage.
What is Kleihauer-Betke test or KB test?
The Kleihauer-Betke test is performed on a maternal blood smear treated with acid and then stained, so the fetal cells remain red and the maternal cells appear as ghosts; cells are counted, and the percentage of fetal cells is determined. 0.1%+ indicates fetal-maternal hemorrhage.
This is the preferred iron supplementation dose and type for preterm infants.
What is 2-4mg/kg of elemental iron?
A congenital infection that is associated with hydrops fetalis due to severe aplastic anemia.
What is parvovirus B19?
This organ is responsible for erythropoiesis in utero before the bone marrow takes over the job.
What is the liver?
In cases of anemia from an RBC enzyme issue, these two enzyme deficiencies are the most common ones.
What are G6PD deficiency (glucose-6-phosphate dehydrogenase deficiency) and pyruvate kinase deficiency?
These both result in a hemolytic anemia.
The preferred specific blood product for neonatal RBC transfusion- important to know when ordering the pRBC's.
What are leukoreduced, CMV-negative, irradiated packed RBCs?
Erythropoietin production switches from this organ to this other organ late in fetal life or shortly after birth.
What are the liver to the kidney?
Liver has a lower 'setpoint' for EPO production (tolerates lower oxygen levels) compared to the kidney.
Polycythemia has this effect on blood viscosity, leading to this consequence.
What is increased viscosity leading to decreased microcirculatory flow leading to compromise in organ function?
These three types of prenatal conditions can cause high erythropoietin levels.
What are IUGR, asphyxia, and maternal diabetes?
These are the indications for partial exchange transfusion in the setting of polycythemia.
What are HCT> 70% with symptoms or HCT >65% with severe symptoms like seizures, respiratory distress or persistent hypoglycemia?
These two laboratory findings are typical of anemia of prematurity as opposed to other types of anemia.
What are low reticulocyte count and normocytic/normochromic RBCs?
This percentage of infants with polycythemia exhibit hyperviscosity syndrome.
What is 47% (about 50%)?
One hematologic and one metabolic abnormality associated with polycythemia.
What are thrombocytopenia and hypoglycemia?
Neonates with increased erythropoiesis-related polycythemia may have "progenitor steal," which leads to decreased megakaryocytes and low platelets. In addition, platelet consumption in microvasculature due to thrombosis from hyperviscosity can also cause thrombocytopenia.
Blood transfusion guidelines on Neosource are based on this RCT.
TOP trial (Transfusion of Prematures) trial
Kirpalani, H., Bell, E. F., Hintz, S. R., et al. (2020). Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants. New England Journal of Medicine, 383(27), 2639-2651.