Special Disease Considerations in the Neonate
Neonates are not simply small adults and the neonatal hematologic system is complex and carefully balanced. The likelihood of hematologic abnormalities in neonates varies from fairly common (anemia) to rare (coagulopathy and polycythemia), but understandi
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Special Disease Considerations in the Neonate Michele P. Lambert
Introduction Neonates, because of their unique status of transitioning from fetal to independent living, deserve special consideration with regard to transfusion for typical blood and coagulation parameters. Most adult laboratory values are fairly stable over time; in contrast, neonatal reference ranges change significantly over the first few days of life and vary with gestational age and birth weight. These values, especially for coagulation factors, may not reach normal adult levels, for 6–12 months. In this chapter, we will discuss the major hematologic abnormalities encountered in the newborn that may require transfusion intervention and a basic approach to their evaluation/management. However, as each of these concepts could easily be a chapter unto themselves, the discussion will be in fairly broad strokes, and the reader will be referred to other sources for further reading.
M.P. Lambert, MD, MTR The Children’s Hospital of Philadelphia, Division of Hematology, Department of Pediatrics, Philadelphia, PA, USA Perelman School of Medicine University of Pennsylvania, Department of Pediatrics, Philadelphia, PA, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 D.A. Sesok-Pizzini (ed.), Neonatal Transfusion Practices, DOI 10.1007/978-3-319-42764-5_3
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M.P. Lambert
Anemia Definition of Anemia The hemoglobin value at which a neonate is deemed anemic depends on both gestational age and birth weight [1]. Generally, anemia is defined as hemoglobin or hematocrit >2 SD below the mean for postnatal age [2] and is a common problem in newborns in the neonatal intensive care unit (NICU). In fact almost 50 % of neonates in the NICU require transfusion, and 90 % of extremely low-birth-weight infants (infants weighing 5 mg/dL) or the cord blood hemoglobin is low (≤8 g/dL) or in rare cases of severe anemia and hyperbilirubinemia associated with sepsis, prematurity, glucose-6-phosphate deficiency, acidosis, or hypoalbuminemia [10]. In contrast, partial exchange transfusion may be indicated in settings of congestive heart failure associated with more chronic anemia as seen in hemolytic disease of the newborn with hydrops or in chronic fetal-maternal hemorrhage or in twin-to-twin transfusion syndrome as this allows for the correction of hemoglobin without substantial changes in blood volume [10]. In conclusion, the causes of neonatal anemia are quite varied, and the management of neonatal anemia varies and may include careful observation and minimizing phlebotomy to transfusion. Careful assessment of the infant and determination of the underlying cause of the anemia is crucial in helping to guide the management. Hemolytic disease of the newborn was not covered in this chapter as it is dealt with elsewhere in this volume.
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Table 3.3 Transfusion guidelines for patients aged
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