anemia & bleeding disorders

8/10/2019 Anemia & Bleeding Disorders

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Hemoglobin (Hb) ConcentrationHemo

globin (Hb) Concentration

Cord Hb concentration :Cord Hb concentration :

* Term infants : 17 gdl (1! " #$ gdl)* Term infants : 17 gdl (1! " #$ gdl)

* %reterm infants : 1! gdl (1& " 1' gldl)* %reterm infants : 1! gdl (1& " 1' gldl)

HB concentrationHB concentration ::

* Delaed claming of te cord+* Delaed claming of te cord+* Holding te infant below te le,el of te* Holding te infant below te le,el of te

lacenta at birt+lacenta at birt+


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-rtrooiesis After Birt-

rtrooiesis After Birt

-rtrooietin rod.ction is switced off-rtrooietin rod.ction is switced off

b te greater a,ailabilit of o/gen+b te greater a,ailabilit of o/gen+

0etic.loctosis from 2 (at birt)0etic.loctosis from 2 (at birt)

3312+12+

Hb le,el to a nadir of 741$ dl b ' " 1$Hb le,el to a nadir of 741$ dl b ' " 1$

wee5s+6 remaining stable for se,eral wee5s6wee5s+6 remaining stable for se,eral wee5s6before grad.lall +before grad.lall +


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Erythropoiesis After Birth/Er

ythropoiesis After Birth/

%retrem infants : Hb le,el more raid%retrem infants : Hb le,el more raid

and more mar5ed sometimes need to beand more mar5ed sometimes need to be

transf.sed (anemia of remat.rit istransf.sed (anemia of remat.rit islabelled non " siological)+labelled non " siological)+

Term infants : as long as te areTerm infants : as long as te are

asmtomatic siological+asmtomatic siological+


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Te Te of AnemiaTe T

e of Anemia

-arl onset anemia :-arl onset anemia :

* Hb le,el of 3 1& gdl (Ht 3 !$2) d.ring* Hb le,el of 3 1& gdl (Ht 3 !$2) d.ring

te first wee5 of life+te first wee5 of life+* %rimarill a emorragic anemia+* %rimarill a emorragic anemia+

8ate onset anemia :8ate onset anemia :

* Hb le,el of 3 1$ gdl after te first wee5* Hb le,el of 3 1$ gdl after te first wee5

of life+of life+


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The Type of Anemia/The T

ype of Anemia/

%rimaril a oregenerati,e anemia%rimaril a oregenerati,e anemia

res.lting from te inabilit of te immat.reres.lting from te inabilit of te immat.re

ematooietic tiss.e to react ade9.atel toematooietic tiss.e to react ade9.atel to

o/ia+o/ia+


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-tiolog of -arl nset Anemia-tiolog of -arl nset Anemia

Twin to twin transf.sion+Twin to twin transf.sion+

;etomaternal transf.ssion+;etomaternal transf.ssion+

;etal emoorage : lacenta re,ia6;etal emoorage : lacenta re,ia6abr.tion6 ,asa re,ia or lacental incisionabr.tion6 ,asa re,ia or lacental incision

at caesarian section+at caesarian section+

;etolacental transf.sion at birt+;etolacental transf.sion at birt+ Cronic or ac.te fetal emolsis : res.sCronic or ac.te fetal emolsis : res.s

disease6disease6 talassemia+talassemia+


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Etiology of Early Onset Anemia/Etiology of Early Onset Anemia/

%erinatal neonatal emorrage :%erinatal neonatal emorrage :

intracranial6 s.baone.rotic fract.res6intracranial6 s.baone.rotic fract.res6r.t.red sleen or li,er6 .mbilical cordr.t.red sleen or li,er6 .mbilical cord

r.t.re or accidents+r.t.re or accidents+

Iatrogenic losses : reeated blood samling+Iatrogenic losses : reeated blood samling+


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Clinical ;eat.res of -arl nset AnemiaClinical ;eat.res of -arl nset Anemia

A+A+ Ac.te blood loss :Ac.te blood loss :

allor6 otension6 oor caillar refill6allor6 otension6 oor caillar refill6

taccardia6 tacnoea+taccardia6 tacnoea+B+B+ Cornic blood loss :Cornic blood loss :

allor6 taccardia6 congesti,e cardiacallor6 taccardia6 congesti,e cardiac

fail.re6 eato slenomegal6


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In,estigationIn,estigation

;.ll blood co.nt and film+;.ll blood co.nt and film+

Blood gro. and coombs= test+Blood gro. and coombs= test+

>aternal 5leia.er test+>aternal 5leia.er test+ Coag.lation screen+Coag.lation screen+

Cranial ?@+Cranial ?@+

-/cl.de red cell abnormalities+-/cl.de red cell abnormalities+ @er.m [email protected] bilir.bin+


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>anagement>anagement

8oo5 for te .nderling ca.se+8oo5 for te .nderling ca.se+

Ac.te blood loss and soc5 : raidAc.te blood loss and soc5 : raid

res.scitation6 gi,e blood of gro. +res.scitation6 gi,e blood of gro. +0es.s negati,e or blood ar,ested from0es.s negati,e or blood ar,ested from

lacenta at once+lacenta at once+

>aintain te airwa and if necessar gi,e>aintain te airwa and if necessar gi,eo/gen+o/gen+


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-tiolog of 8ater nset Anemia-tiolog of 8ater nset Anemia

Anemia of remat.rit+Anemia of remat.rit+

Iatrogenic : reeated blood samling+Iatrogenic : reeated blood samling+

Cronic emolsis+Cronic emolsis+ Hemoglobin abnormalities+Hemoglobin abnormalities+

Bleeding+Bleeding+

@e,ere infection+@e,ere infection+ Iron deficienc (4' wee5s)+Iron deficienc (4' wee5s)+


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Etiology of Later Onset Anemia/Etiology of Later Onset Anemia/

it+ - deficienc (emoltec anemia)6 folicit+ - deficienc (emoltec anemia)6 folic

acidit+ Bacidit+ B1#1#coer and inc deficiencies+coer and inc deficiencies+

>aternal a.toimm.ne disease+>aternal a.toimm.ne disease+

;ail.re of red cell rod.ction+;ail.re of red cell rod.ction+


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Clinical ;eat.resClinical ;eat.res

Anoeic attac5s+Anoeic attac5s+

Tac cardia+Tac cardia+

%oor feeding+%oor feeding+

%oor weigt gain+%oor weigt gain+

##re9.irements in re9.irements in ##" deendent infants+" deendent infants+


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In,estigationsIn,estigations

;.ll blood co.nt6 film and retic.locte;.ll blood co.nt6 film and retic.locte

co.nt+co.nt+

@er.m bilir.bin (total and con


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Transf.se wit %0C if smtomatic to raiseTransf.se wit %0C if smtomatic to raise

te Hb to 1# " 1! gdl ( Ht F !2 )+te Hb to 1# " 1! gdl ( Ht F !2 )+

ol.me of %0C to be transf.sed Gol.me of %0C to be transf.sed G

desired rise in Hb x weight in kg x 4desired rise in Hb x weight in kg x 4


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Bleeding DisordersBleeding Disorders

Common d.ring te neonatal eriod6Common d.ring te neonatal eriod6artic.larl in reterm infants+artic.larl in reterm infants+

Normal emostasis re9.ires ,asc.larNormal emostasis re9.ires ,asc.larintegrit6 normal latelet f.nction and aintegrit6 normal latelet f.nction and a

f.nctional coag.lation sstem+f.nctional coag.lation sstem+


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In,estigating Te Bleeding InfantIn,estigating Te Bleeding Infant

Caref.l istor of famil bleedingCaref.l istor of famil bleeding

roblems6 o.tcome of re,io.s regnancies6roblems6 o.tcome of re,io.s regnancies6

maternal illnesses6 maternal and neonatalmaternal illnesses6 maternal and neonatal

dr.g administration and ascertainment ofdr.g administration and ascertainment ofit+ administration+it+ administration+

; B C and film ( screen latelat n.mbers6; B C and film ( screen latelat n.mbers6

resence of fragmented red cells )+resence of fragmented red cells )+ Coag.lation screen ( %T6 %TT )+Coag.lation screen ( %T6 %TT )+


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; ; % 1$"#$ ml5g+; ; % 1$"#$ ml5g+

%latelet concentrates 1$"#$ ml5g+%latelet concentrates 1$"#$ ml5g+ Croreciitate (Croreciitate (~~factor III)factor III)

anemia & bleeding disorders

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