Anaemia in neonates

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ANEMIA IN NEONATES : 

ANEMIA IN NEONATES

ANEMIA IN NEONATES : 

ANEMIA IN NEONATES In Evaluation Of Anemia 2 Things To Be Taken Into Account. Developmental Process Physiological Need

PHYSIOLOGICAL ANEMIA : 

PHYSIOLOGICAL ANEMIA Alteration in O2 Saturation -- Altering Erythropoitin Response HbF - HbA at Birth Ratio Is 70:30 , at 6 - 12 Mths HbF Is < 2% 8 -12 Weeks Hb Reaches Its Nadir - Stimulates Erythropoitin and RBC Production

ANEMIA OF PREMATURITY : 

ANEMIA OF PREMATURITY Decreased RBC Survival. More Rapid Growth in Preterms Vitamin E Deficiency. Nadir Is Lower in Preterms D/t Decreased O2 Requirement in Healthy Preterms Than in Term.And Not Defective Erythropoitin. Iron Administration Does Not Affect the Nadir. Since They Have Diminished Stores It Is Rapidly Depleted.

HEMOGLOBIN NADIR : 

HEMOGLOBIN NADIR MATURITY TERM PRETERM VLWB Hb Nadir Time of Nadir 9.5 - 11 6 - 12 wks 8 - 10 5 - 10 wks 6.5- 9 4 - 8 wks

ETIOLOGY : 

ETIOLOGY Blood Loss Hemolysis Diminished RBC Production

BLOOD LOSS : 

BLOOD LOSS Acute Blood Loss-- Normal Hematocrite and Reticulocyte Count , Shock Chronic Blood Loss-- Decreased Hematocrite ,Increased Reticulocyte Count, Normotensive Normal Bilirubin

Causes of Blood Loss : 

Causes of Blood Loss Obstetric Causes Abruptio Placenta, Placenta Previa , Incision of Placenta at CS, Rupture of Anomalous Vessels, Hematoma of Cord D/t Varices and Aneurysm, Rupture of Cord D/t Short Cord or Dysmature Cord Occult Blood Loss Feto Maternal-- 8% of All Pregnancies . Fetoplacental Twin - to - Twin

CAUSES OF BLOOD LOSS : 

CAUSES OF BLOOD LOSS Bleeding in Neonatal Period Intracranial Massive Cephalhematomas Retroperitonial Bleeding Rupture of Liver and Spleen Adrenal and Renal H”age Gastrointestinal Bleeding Bleeding From Umbilicus Iatrogenic Causes

HEMOLYSIS : 

HEMOLYSIS Immune Hemolysis Hereditary RBC Disorder Acquired Hemolysis-- Infection, DIC, microangiopathic Hemolytic Anemia

DIMINISHED RBC PRODUCTION : 

DIMINISHED RBC PRODUCTION Diamond - Blackfan Syndrome Congenital Leukemia Infection - Parvovirus and Rubella Osteopetrosis Anemia of Prematurity

DIAGNOSIS : 

DIAGNOSIS FBC / BLOOD FILM Retic Count Coombs Test APT TEST Kleihauer - Betke Preparation-- 50 Ml = 1% Fetal Cells USG Abdomen And Head TORCH Infection Bone Marrow

TRANSFUSION : 

TRANSFUSION PRBC---- Volume 300ml, PCV- 70% , RBC- 210ml, Plasma -90ml Whole Blood- Volume 510ml, RBC- 210ml, Plasma -300ml Amount of Trasfusion-- Patients Blood Volume X Hematocrite Desired - Observed Hematocrite of Packed Cells Approximately 10 ml/kg

INDICATION FOR TRANSFUSION : 

INDICATION FOR TRANSFUSION Infants With Significant Resp. Ds. Or Congenital Cardia Ds. ( Left - Right Shunt) -- 40%< Infants With Immune Hemolytic Anemia With Significant Hemolysis May Need Transfusion at a Later Date. Preterm Babies May Be Quite Comfortable With Lower Hbs (6.5- 7 Mg/dl) ,May Need Transfusion If Sick or Exhibit Poor Wt Gain , Apnea, Tachycardia or Poor Feeding

INDICATION FOR TRANSFUSION : 

INDICATION FOR TRANSFUSION Infants requiring significant ventilation -- FiO2 > 40% & / Or pressor support central Hct < 40% . Infants requiring minimal ventilation -- FiO2 < 35 % , central Hct < 35% .

INDICATION FOR TRANSFUSION : 

INDICATION FOR TRANSFUSION Infants on Supplimental O2 ,Not Ventilated Central Hct - 25% Along With One of the Following. > 24 Hrs Tachycardia and Tachypnea Increase O2 Requirement or Increase CPAP >20% From Previous 48hrs Wt Gain ,10gm/kg/day Over Previous 4 Days, While Receiving 100kcal/kg/day Increasing Episodes of Apnea and Bradycardia Surgery

INDICATION FOR TRANSFUSION : 

INDICATION FOR TRANSFUSION Infants without symptoms central Hct < 20% , & absolute retic count <3% cumulative blood loss of 10 % or more of blood volume in 72 hrs, further bld sampling is anticipated.

PROPHYLAXIS : 

PROPHYLAXIS TERM-- Not on Breast Feed , Will Need Iron Fortified Formula 2mg/kg/day PRETERM Iron Supplementation-- 2-4 Mg/kg/day to Prevent Late Iron Deficiency Anemia , Started Once Full Entral Feed Has Developed Vitamin E -- 15 -25 IU , Given Until 38 -40 Wks Postconception Recombinant Human Erythropoitin -- Decreases the Need for Transfusion

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