Polycythemia in neonatology
also see Polycythemia,
Polycythemia-Hyperviscosity
Syndrome
- Central hematocrit >65%
- Hct: >70% definitely abnormal; 65-70% worrisome if symptomatic; 60-65% gray
zone
Common causes:
- Neonates: Postmature infants, twin-twin transfusion (recipient), IDM
- Other conditions:
- Down syndrome
- Graves
- Hypothyroid
- Beckwith-Wiedemann
- High altitude
Polycythemia can cause:
- low glucose (RBC's consume glucose)
- low platelets
- respiratory distress
- pulm HTN
- thromboses, renal vein
- stroke (rare)
- CHF
- NEC
Presentation:
- Ruddy appearance
- Anorexia, lethargy
- Irritability, Jitteriness, Seizures
- Cyanosis, respiratory distress
- Hypoglycemia
- Hyperbilirubinemia
- Thrombocytopenia
Treatment:
- Phlebotomy, exchange transfusion
- With partial exhange transfusion, the goal is Hct 55 +/- 5
- (85cc/kg * (observed Hct-50%)) / (observed Hct) blood is replaced with NS
or albumin
- for extended discussion, see
Polycythemia-Hyperviscosity
Syndrome
CHLA Board Review 2005