haematologic problems in the newborn(neonatology3)
TRANSCRIPT
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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