Pediatrics fcps approach to anemia in a newborn

1. ANEMIA IN NEWBORN
PRESENTED BY
DR M.ASLAM
FCPS TRAINEE
PAEDIATRIC
DEPARTMENT
GMMMC SUKKUR

2. DEFINITION
 Neonatal anemia is defined as “Anemia developing
during the neonatal period (0-28 DOL) in infants >34
weeks of gestational age that is indicated by central
venous Hb of <13 g/dl or a capillary hemoglobin of
<14.5 g/dl.
 Neonatal microcytosis: MCV of less than 95fL at birth.
 Neonatal hypochromia: MCH of less than 34pg/cell.

3. PHYSIOLOGY
 Normal values for central venous Hb in infants of
>34 weeks of gestational age are between 14-
20g/dl (avg: 17g/dl)
 Normal cord reticulocyte count 3-7%.
 Average MCV of RBCs is 107 fL.
 Premature infants have slightly lower Hb and higher
MCV and Retic count.

4. CAUSES OF NEONATAL ANEMIA
1. HYPOPLASTIC
2. HEMOLYTIC
3. HEMORRAHGIC

5. HYPOPLASTIC ANEMIA
ACQUIRED CAUSES
CONGENITAL CAUSES
DIAMOND-BLACKFAN
SYNDROME
ATRANSFERRINEMIA
CONGENITAL SIDEROBLASTIC
ANEMIA
 INFECTION
 APLASTIC ANMEIA

6. DMS

7. HEMORRHAGIC ANEMIA
ANTEPARTUM NEONATAL
INTRAPARTUM
LOSS OF
PLACENTAL
INTEGRITY
ABRUPTIO
PLACENTAE
PLACENTA
PRAEVIA
TRAUMATIC
AMNIOCENTESIS
ANOMALIES OF
UC OR
PLACENTAL
VESSELS
VELAMENOUS
INSERTION OF UC
VASA PREVIA
UC HEMATOMA
 ENTANGLED
CORD
FETAL CAUSES
TWIN-TWIN
TRANSFUSION

11. HEMORRHAGIC ANEMIA
ANTEPARTUM NEONATAL
INTRAPARTUM
FETOMATERNAL
HEMORRHAGE
CESAREAN
DELIVERY
TRAUMATIC
RUPTURE OF UC
FAILURE OF
PLACENTAL
TRANSFUSION
DUE TO UC
OCCLUSION,
PROLAPSE OR
ENTANGLED.
BLOOD LOSS IN
NEOWBORN
AROUND 25-30ml.
RISK IS INCREASED IN
PRE-ECLAMPSIA,
INSTRUMENTATION.

12. HEMORRHAGIC ANEMIA
ANTEPARTUM NEONATAL
INTRAPARTUM
ENCLOSED
HEMORRHAGE
DEFICINECY OF
VIT K
DEPENDENT
FACTORS
(2,7,9,10)
CAPUT
SUCCEDANEUM
CEPHALHEMATO
MA
SUBGLEAL
HEMORRHAGE
 FAILURE TO
ADMINISTER VIT K AT
BIRTH
ANTIBIOTICS
MATERNAL
INGESTION OF
ANTICONVULSANTS
OPEN BLEED
DIC
SEPSIS
IATROGENIC
BLOOD LOSS
REPEATED
SAMPLING

15. HEMOLYTIC ANEMIA
IMMUNE
HEMOLYSIS
CONGEINTAL
ERYTHROCYTE
DEFECT
NONIMMUNE
HEMOLYSIS
ISOMMUNE
AUTOIMMUNE
GALACTOSEMIA
OSTEOPETROSIS
SEPSIS
TORCH
INFECTION
G6PD DEF
PK DEF
THALASSEMIA
HS
SYSTEMIC
DISEASE

16. CLINICAL PRESENTATION
 Determine the following factors:
 Age at presentation
 Associated clinical features
 Hemodynamic status of the infant
 Presence or absence of compensatory
reticulocytosis
 Family Hx/Obstetric Hx

17. PRESENTATION OF HEMORRHAGIC
ANEMIA
 ACUTE HEMORRHAGIC ANEMIA:
 Pallor without jaundice, cyanosis unrelieved by
oxygen
 Tachypnea
 Decreased perfusion progressing to hypovolemic
shock
 Acidosis
 Normocytic or normochronic anemia
 Reticulocytosis within 2-3 days of event

18.  CHRONIC HEMORRHAGIC ANEMIAl:
 Pallor
 Minimals signs of respiratory distress
 Microcytic or hypochromic RBC indices
 Compensatory reticulocytosis
 Enlarged liver due to extramedullary erythropoiesis

19. PRESENTATION OF HEMOLYTIC
ANEMIA
 Jaundice is usually the first symptom
 Compensatory reticulocytosis
 Pallor
 Hepatospleenomegaly

20. PRESENTATION OF HYPOPLASTIC
ANEMIA
 Uncommon
 Presents after 48 hours of age
 Absence of jaundice
 Reticulocytopenia

21. PRESENTATION OF OTHER FORMS
 TWIN-TWIN TRANSFUSION: Growth failure in the
anemic twin
 OCCULT INTERNAL HEMORRHAGE:
 Intracranial: bulging anterior fontanelle and
neurologic signs(altered mental status, apnea,
seizures)
 Visceral hemorrhage: most often liver is damaged
and leads to abdominal mass.
 Pulmonary hemorrhage: radiographic
opacification of a hemithorax with bloody tracheal
secretions.

25. KLEIHAUER-BETKE TEST FOR FMH: