Anemia in the newborn
also see Normal values, CBC, Anemia, physiologic, Hemolytic disease of the newborn

Presentation: Pallor, CHF, shock

Etiologies (think placenta, cord...)

• Abnormal cord insertions-Transplacental
• Placenta previa or abruptio hemorrhage
• Umbilical cord disruption-Twin-twin transfusion
• Cord clamping problems
• Internal hemorrhage-Cephalohematoma
• Sepsis
• Prematurity

Newborn anemia-workup

• CBC with differential and smear
• Reticulocyte count
• Blood typing (mom and baby)
• Coombs
• *Non-immune workup may require: enzyme studies, electrophoresis, membrane studies, ultrasound of brain, liver, spleen, adrenal

Flow diagram

1. If Hb low, start with retic count
2. If retic count
   1. low: consider congenital hypoplastic anemia. End.
   2. normal or high: do Coombs' test.
3. If Coombs' test
   1. positive: consider immune hemolytic anemia ( incompatible ABO, Rh, Minor blood group i.e. Kell). End.
   2. negative: do MCV.
4. If MCV
   1. low: consider chronic intrauterine blood loss or alpha thalassemia syndromes. End.
   2. normal or high: do peripheral blood smear
5. If smear
   1. abnormal: consider hereditary spherocytosis/elliptocytosis, pyruvate kinase deficiency, G6PD Deficiency, DIC
   2. normal, consider:
      1. blood loss: i.e. iatrogenic sampling, fetomaternal or fetoplacental, twin-twin, or internal hemorrhage
      2. infection: i.e. C. welchii
      3. rare misc: ie hexokinase deficiency