This document discusses neonatal hematological disorders, including physiological anemia of the newborn, pathological anemia, and hemorrhagic disease of the newborn. Physiological anemia occurs as hemoglobin levels normally decrease after birth. Pathological anemias can result from blood loss, hemolysis, or diminished red blood cell production. Hemorrhagic disease of the newborn is caused by vitamin K deficiency and can cause bleeding at injection sites, in the GI tract, or intracranially. Treatment involves vitamin K supplementation to prevent hemorrhagic disease, and blood transfusions to treat blood loss or low hemoglobin levels.

1. Neonatal
hematological
disorders

2. Physiological anemia of the
newborn :
• Normal hemoglobin level in term infants at
birth is 14 : 20 g/dl
• A physiologic decrease of hemoglobin is
noticed :
• At 8 – 12 wk in term infants ( Hb , 9-11 g/dl)
• At 6 wk in preterm infants ( Hb , 7- 10 g/dl)

3. Etiology :
• In utero , fetal O2 saturation is low, and level of
erythropoietin is high, result in stimulation of
erythropoiesis.
• After birth, O2 saturation is high and level of
erythropoietin is low, result in decrease of
erythropoiesis, so Hb level is decreased .
Treatment :
• No treatment ( It is physiological anemia )

4. Pathological anemia in
the neonate

5. 1. Blood loss
• Prenatal:
Placenta previa
Feto-maternal bleeding
Twin – to – twin transfusion .
• Postnatal :
Hemorrhagic disease of the NB.
• Natal:
Birth Trauma .
Frequent blood sampling for investigations .
2. Hemolysis
3. Diminished RBC production
A . Infection (Rubella).
B . Congenital leukemia .
c . Congenital pure red cell anemia.

6. Clinical manifestations
• Acute blood loss :
• Pallor, shock
• anemic HF
( tachypnea, tachycardia, hepatomegaly ) .
• Chronic anemia :
• Pallor, poor weight gain, poor feeding,
decreased activity, apnea, less distress, and if
severe, heart failure .

7. Investigations:
1-Complete blood pictures
2-Reticulocytic count
2-Blood indices
3-Coomb’s tests
4-S.bilirubin

8. Treatment
I. Blood transfusion
• Blood should be fresh ( less than 3 days )
• Tests for CMV antibody, antibody to
HIV, and those for Hepatitis B and C.
• Irradiated blood in case of immune
compromised infant.
• Volume : 10-20 ml/kg
II.Treatment underlying cause

9. A. Deficient clotting factors
1.Transitory deficiencies of the vitamin K-dependent
factors ( hemorrhagic disease
of the newborn )
2.With associated diseases : DIC, and significant liver
disease .
3.Inherited abnormalities of clotting factors: Classic
hemophilia ( F8 deficiency .
B. Platelet problems
Thrombocytopenia and defective platelet function.
C- Vascular problems: Hypoxia, acidosis
D- Fibrinolysis: DIC

10. Late onsetclassicEarly onset
2 wks : 6 months2 : 7 days1st dayonset
Absence of bacterial
intestinal flora (that
form vitamin K):
Total parenteral
alimentation .
Broad spectrum
antibiotics.
Malabsorption
disease (biliary
atresia, cystic
fibrosis,
Decrease intake:
(Breast milk is a
poor source of
vitamin K)
Immature liver
Decrease vit K
stores ( common in
preterm )
Maternal drugs
that inhibit vit K
synthesis :
-Anticonvulsants
-Anticoagulants
-Antituberculous
Causes
Dependent on cause2% of neonate not
given vitamin K at
birth
Very rareincidence

11. Clinical picture :
• Hemorrhagic anemia ( pallor, up to
shock )
• Site of hemorrhage: GIT, Ear, Nose,
Throat , Intracranial, Circumcision ,
Injection site.

12. Investigations:
• PT, PTT, and clotting time are prolonged.
• Levels of factors 2, 7, 9, 10 are reduced.
• Bleeding time, platelets count are normal.
Prevention :
1mg vitamin K1 ( konakion ) I.M at time of birth

13. Treatment :
• I.V. infusion of 1-5 mg vit K will lead
to cessation of bleeding within a few
hours.
• Fresh frozen plasma (10 ml/ kg) in
cases of serious bleeding, prematures,
those with liver diseases and
ineffective vit K therapy.
• Whole blood transfusion (in case of
marked hemorrhage ) may be required
.

14. 1- causes of hemorrhage in the newborn
2- swallowed blood syndrome :-
Clinically: Blood vomiting or bloody stools are passed
during the 2nd or 3rd day of life
cause: swallowing of maternal blood during delivery or
from a fissure in the mother’s nipple .
DD: It may be confused with hemorrhage from GIT of
the newborn .
Diagnosis: The Apt test is used to DD, based on the fact
that the infant’s blood containing hemoglobin mostly
HbF is alkali-resistant , stay pink
maternal blood ( HbA ) forms alkaline hematin , turns
yellow

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