This is slide gives u quick recap on anemia of prematurity

1. Anemia of prematurity

2. Etiology
• Impaired erythropoietin production
• Blood loss from phlebotomy…2 to 4 mL/kg per week
• Reduced red blood cell life span…
• Iron depletion

3. • Red blood cell survival in newborn term infants is approximately 60 to
80 days, but decreases with decreasing gestational age to a range of
45 to 50 days in extremely low birth weight infants (ELBW) (BW below
1000 g
• Increased susceptibility to oxidant injury may contribute to shortened
red cell survival in the neonate

4. Anemic preterm infants may be less able to maintain oxygen delivery
because of the following:
• Concomitant respiratory disease, such as respiratory distress
syndrome and bronchopulmonary dysplasia, resulting in hypoxia.
• Limitations on maximum arterial oxygen saturation and oxygen
tension for infants requiring respiratory support, because hyperoxia
increases the risk of bronchopulmonary dysplasia and retinopathy of
prematurity.
• Hemoglobin F (HbF)-containing red cells in the preterm infant have a
considerably higher oxygen affinity than adult red blood cells,
resulting in reduced delivery of oxygen to tissues

5. CLINICAL AND LABORATORY FEATURES
• Anemia of prematurity (AOP) typically occurs at 3 to 12 weeks after
birth in infants less than 32 weeks gestation.
• The anemia typically resolves by three to six months of age
• average hemoglobin concentrations fell from 18.2 g/dL at birth to a
mean nadir of 9.5 g/dL at six weeks of age
• HCT nadirs of 21 percent in infants with birth weights (BW) less than
1000 g, and 24 percent in infants with BW between 1000 and 1500 g

6. Symptoms associated with AOP include
• tachycardia,
• poor weight gain,
• increased requirement of supplemental oxygen, or
• increased episodes of apnea or bradycardia

7. Lab finding
• Peripheral blood smear demonstrates normocytic and normochromic
red blood cells
• The reticulocyte count is low, and red blood cell precursors in the
bone marrow are decreased
• Serum concentrations of erythropoietin (EPO) are low in preterm
infants

8. MANAGEMENT
• iron supplementation…. 2 to 4 mg/kg per day through the first year of
life. the use of iron-fortified formula compared with nonfortified
formula allows for greater iron substrate when erythropoiesis is
stimulated .Iron supplementation does reduce iron-deficiency
anemia,
• Red blood cell transfusions are primarily used to treat infants with
AOP
• Blood sampling should be limited

9. Laboratory monitoring
• (HCT) or hemoglobin (Hb) should be monitored on a weekly basis in
extremely low birth weight (ELBW) infants (BW less than 1000 g) in
the first weeks of life
• In asymptomatic infants, measuring a reticulocyte count at
approximately four to six weeks after birth is used to evaluate
whether a red blood cell (RBC) transfusion may be needed.
• an absolute reticulocyte <100,000/microL (<2 percent) is often used
as a criterion for RBC transfusion in asymptomatic infants with a low
HCT (less than 20 percent) or Hb (less than 7 g/dL).

10. RBC transfusion
Indications
• a low HCT (less than 20 percent) or Hb (less than 7 g/dL)…if
asymptomatic
• his/her requirement for respiratory support, and
• the presence of symptoms consistent with anemia (eg, tachycardia,
poor weight gain, increased requirement of supplemental oxygen, or
increased episodes of apnea or bradycardia).

11. Erythropoiesis stimulating agents
• recombinant EPO
• ESAs have also been proposed as neuroprotective agents that reduce
poor long-term neurodevelopment outcome

12. the routine use of EPO in neonates is NOT
recommended
• increased risk of retinopathy of prematurity (ROP
• EPO is a costly intervention
• Late administration of EPO reduces the number of transfusions, but
the limited benefit does not justify its use.