Neonatal anemia

Introduction In the first 2 weeks after birth, venous hemoglobin (Hb) is less than 130g/L (13g/dl), or capillary Hb <145g/L (14.5g/dl), which can be diagnosed as neonatal anemia. Neonatal anemia can be divided into several types: neonatal hemorrhagic anemia, neonatal hemolytic anemia, neonatal ischemic anemia, here mainly talk about neonatal hemorrhagic anemia. In the case of blood transfusion between the fetus and the fetus, the donor should exchange blood transfusion or simply transfuse to increase the hematocrit to a safe level. The recipient may have polycythemia, which may require partial exchange transfusion (exchanging bloodletting) with colloidal fluid. Hematocrit is reduced to a safe level (usually <65%).

Cause

1. Prenatal bleeding: mainly through the placenta blood loss, including fetal-placental bleeding, fetal-female blood transfusion and inter-fetal transfusion. Because of the concealment of bleeding, the amount of bleeding is not equal, the bleeding rate can be urgent and slow, so the clinical manifestations are different.

2. Blood loss at birth: Mostly caused by obstetric accidents during delivery, placenta and umbilical cord deformity.

(1) Abnormal placenta: severe blood loss often occurs in the placenta previa, early placenta stripping or cesarean section, which causes miscarriage of the placenta and causes blood loss. Placental malformation is more common with multi-leaf placenta, and each leaf emits a fragile vein branch to the placenta. The blood vessel is prone to bleeding.

(2) Umbilical cord abnormality: normal umbilical cord may suddenly bleed due to excessive involvement, umbilical cord malformation such as umbilical cord hemangioma, vagus blood vessel, etc., the latter is one or more blood vessels before the umbilical cord reaches its implantation site, and its blood vessel wall is thin. It lacks the protection of the umbilical cord-like tissue and is easily broken. The umbilical cord is placed in the placenta and the blood vessels are also passed between the amniotic membrane and the chorion without protection. The incidence of bleeding is 1% to 2%.

3. Blood loss after birth: Blood loss after birth is more common in umbilical, gastrointestinal and internal bleeding. In recent years, blood loss has also increased due to hospital-based diagnostic blood sampling.

an examination

Related inspection

Hemoglobin alkaline spotting red blood cell count neonatal hemolysis screening fetal hemoglobin (HbF) acid elution test erythrocyte adenylate kinase

Acute blood loss with low volume shock should be corrected by direct transfusion of whole blood or bagged red blood cells through the umbilical vein catheter, 15ml/kg infusion for 5 minutes to 10 minutes or more, and the infusion can be repeated until the normal cycle is resumed. If you are unable to transfuse blood immediately, you can start to enter the same volume of colloidal fluid (5% human albumin or fresh frozen plasma) or 0.9% saline to support the circulation. If the shock persists, the blood transfusion, colloidal fluid or saline should be repeated. The central vein was monitored by umbilical vein cannulation (the X-ray was used to determine the catheter head above the diaphragm) to help determine when the blood circulation loss was restored.

Differential diagnosis

Neonatal hypophosphatemia: Vitamin D-resistant rickets is a tubular degenerative disease with hypophosphatemia and hypocalcemia. Familial hypophosphatemic rickets are caused by renal tubular defects and loss of phosphorus in the kidneys, resulting in disorder of calcium and phosphorus metabolism, causing rickets. The genetic method is sexually induced and inherited, and it has no response to the general physiological dose of vitamin D, so it is also called anti-vitamin D rickets and sexually linked hypophosphatemia.

Neonatal neutrophilia: Peripheral blood leukocytes are often increased in patients with sclerotin, mainly neutrophils. Clinical manifestations vary widely, the main clinical types are purulent meningoencephalitis, sepsis and perinatal infection, leading to miscarriage or neonatal sclerotia.

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