haematologic problems in the newborn(neonatology3)

8/20/2019 Haematologic Problems in the Newborn(Neonatology3)

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Haematologic problems in the

Newborn

Dr. Ayede A.I.

Department of Paediatrics

University College Hospital

Ibadan.


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Haematologic Problems in the

Newborn

• Anaemia incl!ding haemolytic disorders"

• Hyperviscosity states

• #leeding Disorders


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Haematological Indices

Hb

$erm #abies %&'()g*dl cord blood%+.,g*dl"

Preterm #abies %&g*dl at (,w-s %(g*dl/termbabies"

• Haematocrit &0 ' +01 lower in preterm"


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WBC

• Day % + ' 203)))*4l• 5ee- % , ' %+3)))*4l

• % 6onth + ' %&3)))*4l

7al!es are a little lower in preterms.


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Ne!trophils

Day % 0) ' ,)1

Day & 20 ' +)1Day 8 20 ' &01

2 6onths (0 &01

9ymphocytes

Day % 2%1

DA: 8 &%1Day %& &,1

N#; 9ymphocyte co!nt is < Ne!trophil frm 0day

,yrs


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Platelets %0)3))) ' &))3)))*4l

!p to +))3)))*4l by ( ' & months"

=etics (,1 Day %

).0 ' 01 Day 8

) ' ).01 % 6onth


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Physiology

Normal Development;

IN U$>=?

Aortic ?(

sat. is abo!t &01Increased >rythropoietin prod!ction3

erythropoiesis3

=etics @2 ' 81


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Physiology cont

Beotal Hb increases with gestational age

Beotal blood vol!me is abo!t %%0ml*-g

Beotal blood vol!me is abo!t

%%0ml*-g ' 80ml baby

&)ml placenta


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AFTER BIRTH

?( sat. increases to 01

=ed!ced >rythropoietin prod!ction3 >rythropoiesis

and =etics

Hb red!ces to minim!m val!es by , ' %( w-s of life

@after which erythropoiesis res!mes again

HbA*HbB starts to increase

(32 DP increase

?( delivery to tiss!e increases


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ANA>6IA

Hb / normal for gestational and postnatal age.

ANAEMIA OF PREMATURIT

>Eaggeration of physiologic anaemia

=easons;

6in val!es reached earlier than in term babies.+w-s @ % ' 2mths

=ed!ced rbc s!rvival


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• Iatrogenic ' repeated phlebotomy for

investigations

• =elatively more rapid somatic growthrate

• 7itamin > deficiency

• Preterm infants start to prod!ce

erythropoeitin again when Hb falls to

8 ' g*dl in contrast to %) ' %%g*dl in

term infants beca!se their tiss!es have

lower ?( reF!irements.


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6anifestations; Palor

Apnoea

Poor weight gain

$achypnoea

$achycardia


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Management!

#lood transf!sion if symptomatic. %)ml*-g ofpac-ed cells over % ' 2hrs

Bolic acid 0mg wee-ly to babies / (-g from(w-s of age

%)mg G tocopherol acetate @vit > daily tobabies / %.0-g from (w-s.

Be?& ' 0)mg dly or +mg.-g*d of elemental ironfrom (-g or %) ' %&w-s of age

rH!>p? %)) ' ()) i!*-g 0*w- or &))i!*-g*d2*w- J iron J vit >


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ANAEMIA

>arly ?nset ' @first few days after birth

most freF!ently d!e to haemolytic diseaseor haemorrhage

Ca!ses; =h haemolytic disease

A#? haemolytic disease

Infections; ?ther ca!ses of haemolysis are;

+PD deficiency3 spherocytosis3

G thal

Betal haemorrhage ' abr!ptio placentae


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Betal haemorrhage ' abr!ptio placentae3

placenta previa3 7asa previa @APH

Beto maternal transf!sion$win twin transf!sion

Neonatal Haemorrhage ' birth tra!ma

Cephal haematoma

!bgaleal haematoma

=!pt!re liver3 spleen3 etc

Congenital hypoplastic anaemia

Associated wt HI7


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Clinical assessment

History!"

APH3 m!ltiple delivery Diffic!lt delivery

Instr!mental delivery

Poor feeding3 breathlessness


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>Eamination; Colo!r3 #r!ises3

Cephalhaematoma3 rigid abdomen3 P!lse

vol!me3 Heart =ate3 #P3 =esp =ate

Investigation; PC73 Hb3 5#C3 Peripheral

Bilm app.

$reatment; depends on severity

#hoc$ @#P/(0mmHg3 PC7/2)13 pH/8.%

$ransf!se %0()ml*-g whole blood over

0%)mins


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If not in shoc- b!t anaemia is severe3

ive ()ml*-g of whole blood over (2hrswith I7 fr!semide (mg*-g OR

pac-ed cells %)%0mls*-g @(2mls*-g*hr

(ml*-g of pac-ed cells will raise Hb by ).0 %g*dl

7ery servere anaemia Hb/,g*dlK one volCCB K >#$ with

pac-ed cells


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%ate onset Anaemia

Appears later in neonatal period.

Ca!ses;

• 6ild HDN

• Haemolytic disease of newborn

• Chronic blood loss eg l bleeding

• Infections with DIC

• +PD def.3 spherocytosis3 G thalasaemia• Congenital marrow aplasia3 hypoplasia

• =epeated venep!nct!re


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HPER&I#CO#I#T #TATE#

Polycythaemia; 7eno!s PC7 < +01

As veno!s PC7 rises above +01 viscosity of blood increases3 and )( transport red!ces.

Aetiology;

• Placenta ins!fficiency

• 6aternofoetal transf!sion from delayed cord

clamping

• $wintwin transf!sion

• ID6


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• Congenital adrenal hyperplasia

• $risomy %23 %,. (%

• Neonatal thyrotoEicosis

• #ec-with 5iedemann syndrome

• 6aternal dr!gs li-e propanolol


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Clinical feat!res;

6ay be asymptomatic

enL Plethora3 Ma!ndice3 cyanosis3 prolonged

capillary refill

=espL tachypnoea3 dyspnoea

I$L feeding problems3 N>C

CNL irritability3 Mitteriness3 lethargy3 sei!res


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%aboratory'

hyperbilir!binaemia

Hypoglycaemia

Hypocalcaemia

Prominent vasc!lar ma-ings on C=


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6anagement

PC7 / 8)1 and asymptomatic observe

ymptomatic erythrophoresis

7ol@ml O bld vol E @observeddesired pcv

act!al pcv


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Blee(ing )isor(ers

$ests of coag!lation;

P$ L dependent on factors II 7II3 I3

meas!res vit def.

P$$L meas!res factors II3 I3 7II3 3 73 II3 I

Prolonged in DIC3 heparin therapy3

haemophylia and severe vit- def

#leeding time

Platelet co!nt


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Haemorrhagic dsE of the Newborn

After birth3 there is a slight red!ction in

levels b*w (nd and 8th days of life

>Eaggeration of this process leads to HDN

• >arly / (&hrs

• 9ate < % wee-


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Pre(is*osing +actors!

#irth asphyEia6aternal dr!gs li-e phenobarb3 AA3

co!marin

>Ecl!sive breastfeeding

#roadspectr!m antibiotic therapy

Perenteral n!trition


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Clinical feat!res;#leeding which tends to be l3 nasal3

s!bgaleal3 intracranial3 post circ!mcision

5ell childP$3 P$$ prolonged

$hrombin time and fibrinogen levels are

normal


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$reatment;

I7 vit % %0mg stat>#$ in severe cases with fresh whole blood

Can be prevented by admin of im vit %mg

at birth ).0mg wee-ly to babies onperenteral n!trition.


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Disseminated intravasc!lar coag!lopathies

@DICPredisposing factors;

• severe birth asphyEia3 septicaemia

• hypothermia• hypotension

• acidosis

• hypoEia


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clinical presentation;

• petechiae

• prolonged bleeding from p!nct!re sites• spontaneo!s bleeding

laboratory;

• prolonged P$3 P$$3 $hrombin time• increased BDP3 =ed!ced platelets

/%))3)))*mm2

• fragmented rbcs on peripheral blood film


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$reatment;

$reat !nderlying ca!se3BBP %)%0ml*-g


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Platelet transf!sion3

>#$ with fresh whole bloodQ7it

Neonatal thrombocyto*enia

Ca!ses Lepticaemia3 DIC3 transient I$P3 asabach

6erritt syndrome

Presentation; p!rp!ra3 ecchymosis3 large

haematomas

haematologic problems in the newborn(neonatology3)

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