Neonatal hematologic conditions

1. NEONATAL HEMATOLOGIC
CONDITIONS
Soumya Ranjan Parida

2. RED BLOOD CELL DISORDER
HEMOGLOBIN LEVEL IN AN INFANT IS
SIGNIFICANTLY INFLUENCED BY THE AMOUNT
PLACENTAL TRANSFUSION

3. Placental vessels : 75- 125 ml of blood
one – fourth in first 15 secs.
one – half at end of first min.

5. Anemia(physiologic)
• Term infants – 11.4 +/- 0.9gm/dl
• Preterm : 7 – 10 gm/dl

6. Bleeding Disorders
HEMORRHAGIC DISEASE
• Vitamin K–dependent clotting factors (II, VII,
IX, and X).
• Bleeding occurs in 0.25–1.7% of newborns
who do not receive vitamin K prophylaxis after
birth, generally in the first 5 days to 6 weeks in
an otherwise well infant.

7. Hemolytic Disease
Immune
Alloimmune & Autoimmune
Non immune
Membranopathies, enzymopathies,
Hemoglobinopathies

8. Three Types of HDN( Allo)
• ABO
• “Other” – unexpected immune antibodies
other than anti-D – Jk, K, Fy, S, etc.
• Rh – anti-D alone or may be accompanied by
other Rh antibodies – anti-C, -c, -E or –e.

9. ABO Hemolytic Disease
• Mother group O, baby A or B
• Group O individuals have anti-A, -B and fetal RBCs
attacked by 2 antibodies
• Occurs in only 3%, is severe in only 1%, and <1:1,000
require exchange transfusion.

11. “Other” Hemolytic Disease
• Uncommon, occurs in ~0.8% of pregnant women.
• Immune alloantibodies usually due to anti-E, -c, -
Kell, -Kidd or -Duffy.
• Anti-K
– disease ranges from mild to severe
– over half of the cases are caused by multiple blood
transfusions
– is the second most common form of severe HDN

12. Rh Hemolytic Disease
• Anti-D is the commonest form of severe HDN. The
disease varies from mild to severe.
• Anti-c can range from a mild to severe disease - is the
third most common form of severe HDN

13. • The prevalence of Rh –ve genotype is zero
in china & Japan
• 0.05ml – 0.1 ml fetal blood – immunisation
• Toxemia, Manual removal of placenta , CS
increases prevalence

14. Anemia( Iatrogenic)
• Frequent blood sampling
• Removal of 20% of blood volume
• 1500 gm infant – 25 ml blood loss – Anemia
• Approx 10% of blood loss is hidden.

16. Hemoglobinopathies
• Predominant Hb is HbF(α2γ2)
• Abnormalities of β chain production do not
manifest ( SCD, β thalassemia)

17. Enzymopathies

18. Membranopathies

19. Elliptocytes

20. Evaluation Of anemia
• Site Of blood sampling
• Capillary Or Venous ??????

21. • Duplicate Capillary Sampling : Difference 0.8
gm/dl
Capillary > Venous
Difference upto 3.6gm/dl
Found in both term & preterm infants
Persists upto 6wks – 3months
Most marked in premature infants

23. Leucocyte Disorder

24. Band cell/ Non segmented neutroplil