Anaemia affecting babies

1. NEONATAL ANAEMIA
NEONATAL ANAEMIA

2. Outline
 Definition
 Normal values
 Erythropoiesis
 Pathophysiological classification.

3. DEFINITION
 A reduction in red cell volume or hemoglobin
concentration below range of values occurring in
healthy newborn with respect to gestational age.
 Is there a cut off? Depends on
 Post natal age of neonate
 Birth weight
 Site of sampling (capillary vs. venous)
 Term infant at birth, venous sample 14-20g/dl..
Average 17g/dl
 Few clinical disturbances occur till Hb 7-8g/dl ??
2/8/2024

4. Normal Hb Levels
What shall we say then,
 cord blood levels <13g/dl in term & premature (<36 wks
gestation) should be interpreted as abnormal
 In very premature infants < 26wks gestation, values as
low as 12g/dl may be acceptable
 If anemia is confirmed, a prompt and careful search for
the cause should be initiated.
2/8/2024

5. Development of
erythropoiesis
 Hematopoiesis in embryo and fetus
 Hepatic -chief site 3-6mo in utero
 Myeloid – takes over 6 mo
 First cells produced in embryo are red cells
2/8/2024

6. Erthropoiesis after birth
 In the bone marrow
 Rate of Hb synthesis and red cell production
dramatically decreases(nadir 2nd wk, then increase to
max at 3/12 2ml packed cells/day
 Sudden decrease is initiated by equal sudden increase in
tissue [oxygen ]at birth
 At birth 55-95% is HbF , thereafter HbA more
2/8/2024

7. 2/8/2024

8. Control of Erythropoiesis
 Erythropoiesis is controlled by a negative feedback loop
involving erythropoietin (EPO) .
 ↓ RBC mass - ↑ EPO which drives erythropoiesis to ↑RBC
mass which in turn reduces EPO production
2/8/2024

9. Pathophysiological
classiffication
1. Anemia due to blood loss(hemorrhage)
2. Anemia due to increased destruction of RBCs
(hemolysis)
3. Anemia due to decreased red cell production
2/8/2024

10. Blood loss
 Prenatal or at birth
 Laboratory sampling
 Occult hemorrhage before birth-fetal to maternal
hemorrhage, twin to twin transfusion.
 Obstetric accidents-umbilical cord rupture in
precipitous labour, unusually short, entangled around
neck, traction with forceps, arterial aneurysm. APH
 Inadvertent incision during CS
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11. TWIN TO TWIN TRANSFUSION
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12. ct
 Internal hemorrhage
 Traumatic delivery-subdural, sub arachnoid,
cephalohematoma, subaponeurotic
 Breech delivery-adrenals, kidney, spleen , retroperitoneal,
liver
 Intraventricular (50% of those <1500),SAH
 Bleeding disorders acquired or congenital
 Less cmn causes-maternal antiepileptic use, fetal
adenovirus, CMV ix, hemangiomas of GIT
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13. phlebotomy
 Repeated phlebotomy, confirmed major cause of
anaemia
 It hastens onset/worsens severity
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14. Hemolysis
 Immune mediated-most common cause of neonatal
hemolysis; Rhesus incompatibility, ABO, Minor blood
group incompatibility, maternal infantile AIHA, drug
induced penicillamine, α-methyl dopa.
 Infection –bacterial sepsis,TORCHES, Malaria,
adenovirus.
 Hereditary red cell membrane defects hereditary
spherosocytosis
 Hereditary enzymopathies G6PD, pyruvate kinase def.
 Hereditary hemoglobinopathies α –thal, γ-thal.
2/8/2024

15. Decreased erythropoiesis
 Congenital infection-rubella,CMV,adenovirus,parvovirus
 Congenital dyserythropoietic anaemia, anemia, early
jaundice,hepatosplenomegally
 Congenital leukemia,down syndrome, osteoporosis
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16. Physiologic anaemia of
prematurity
 The Hb of normal term infants usually decreases over
first few weeks of life (physiologic anaemia of
infancy).nadir 11-12g/dl, 8-12wks.
 Physiologic process , asymptomatic, requires no
treatment.
 Preterms have an exaggerated decrease (physiologic
anaemia of preterms). nadir 7-8g/dl, 4-8wks,more
immature, lower nadir.
2/8/2024

17. 2/8/2024
 The physiological phenomenon is due to:-
 Increase in tissue oxygenation at birth (placenta to lungs)
 Rapid body growth
 Shortened rbc lifespan 80d vs 120d
 Low blood erythropoietin due inadequate production and bunted
EPO response to decreasing Hb.
 Decrease in hematopoietic activity.