ANEMIA IN THE NEW

BORN
Yetty Movieta Nency
Pediatric Hematology Oncology Division.
Faculty of Medicine, Diponegoro university, Semarang
PATHOPHYSIOLOGY
• Erythropoietin (EPO): stimulates maturation of red
blood cell (RBC) precursors.
• The major impact of anemia is decreasing of oxygen
delivery to tissue.
• Chronic consequences : poor growth, decreased
activity and limited cardiovascular reserve.
• ANEMIA is define as HCT < 45% in term infant
CAUSE OF ANEMIA IN NEONATAL
• 1. BLOOD LOSS
• 2. INCREASING OF DESTRUCTION
• 3. DECREASING OF PRODUCTION
BLOOD LOSS
• Blood loss, the commonest cause including:
• A. Obstetrical causes: placental abruption, placenta previa,
rupture of a placental vessels
• B. Feto-maternal transfusion
• C. Feto-placental
• D. Twin-twin transfusion
• E. Internal hemorrhage such as intracranial hemorrhage,
subgaleal hemorrhage, cephalohematoma etc
• F. Iatrogenic ( sampling of blood for laboratory test: . This is the
commonest cause of anemia in small preterm infants.
Increasing RBC Destruction
• A. Intrinsic causes: Hereditary RBC disorders including:
• •RBC Enzyme defects (e.g., G6PD deficiency)
• •RBC membrane defects (e.g., hereditary spherocytosis)
• •Hemoglobinopathies (e.g., α-thalassemia)
• B. Extrinsic causes:
• •Immune hemolysis : ABO/ Rh incompatibility
• -Hemangiomas (Kasabach Merritt syndrome)
• •Acquired hemolysis:
• -Infection
• -Vitamin E
• - Drugs
REDUCING OF RBC PRODUCTION
• Anemia of prematurity due to transient
deficiency of erythropoietin
• B. Aplastic or hypoplastic anemia (e.g., Diamond-
Blackfan)
• C. Bone marrow suppression (e.g., with Rubella
or Parvovirus B19 infection)
• D. Nutritional anemia (e.g., iron deficiency),
usually after neonatal period
CLINICAL FINDING
• Vary with the severity of anemia and other associated
conditions.
• There may be no signs with mild anemia.
• With more severe anemia, findings include:
• •Pallor
• •Tachycardia
• •Poor feeding
• •Hepatosplenomegaly (hemolytic disease)
• •Jaundice
• •Hypotension
Diagnosis TOOL
• 1. History:
- Family: Anemia, ethnicity, jaundice •
- Maternal and perinatal: Blood type and Rh; anemia; complications
of labor or delivery
- Neonatal: Age of onset; presence of physical findings
2. Laboratory Evaluation
•CBC with platelets, smear and reticulocyte count
•Blood group and type, Direct Antiglobulin test (Coombs Test)
•Bilirubin (total and direct)
•Ultrasonogram for internal bleeding (head, abdomen)
• Rarely, hemoglobin electrophoresis and RBC enzymes
• Not necessary to do BMP
MANAGEMENT
• will depend on cause and severity of anemia.
• Anemia of prematurity: The main management
are:
• Limit blood drawing for laboratory tests
• Recombinant human erythropoietin (r-Hu-EPO)
• Transfusion with packed red blood cells (PRBCs)
for severe anemia
• Other causes of anemia: Treat underlying cause
when feasible.
Severe Anemia
• Severe neonatal anemia need packed red cell transfusion.
• Very severe anemia caused by hemolytic disease may also
transfusion, and Exchange transfusion.
• Clinical factors that have been suggested as helpful in making
decisions about whether to transfuse include :
- poor weight gain,
- respiratory irregularities (including apnea),
- and hemodynamic perturbations (particularly tachycardia).
- A reticulocyte count of at least 75.0 to 100.0×109/L is a
reliable predictor that an increase in Hb is imminent and,
therefore, that a RBC transfusion is unnecessary
THANK YOU