Out for Blood: Neonatal Hematology Review - FANNP

FANNP 23RD NATIONAL NNP SYMPOSIUM: CLINICAL UPDATE AND REVIEWSticking together…Coagulation◦ The Labs• Platelet count – platelet #• Prothrombin time (PT) – extrinsic &common portions of the coagulationcascade• Partial thromboplastin time (PTT) –intrinsic & common portions of thecoagulation cascade• Fibrinogen – circulating level of thisprotein substrate, required for clotformation• FDP/FSP – fibrinolytic activity• D-Dimer – fibrin degradation productHemorrhagic DiseaseHemorrhagic tendency caused byvitamin K deficiency AND decreasedactivity of factors II, VII, IX, XHemorrhagic Disease…Etiology◦ Primary vitamin K deficiency◦ Vitamin K is required for…• Activation of clotting factors II, VII, IX, X• Activation of proteins C & S after liver synthesiss◦ Vitamin K is affected by…• Lack of bacterial presence◦ Intestinal flora is needed for vitamin K synthesis◦ Intestinal tract is virtually free of bacteria untilfeedings initiated◦ Antibiotics can alter intestinal colonization◦ May result in intraventricular/intracranialhemorrhage3 Types Early, Classic, Late◦ Early• Least common• Bleeding within 1 st 24 hrs of life• Typically associated with maternalanticonvulsant therapy• Cannot be prevented withadministration of vitamin K• Therapy = treatment of mother withlarge doses of vitamin K >/= 10 daysprior to delivery3 Types Early, Classic, Late◦ Classic• 2-5 days of life• Generalized and occasional dramaticbleeding (GI, umbilicus, circ site, skin,internal organs)• Typically breast fed infant who has notreceived prophylactic vitamin K and isnot taking adequate amounts of EBM• At Risk late preterm, near term, postc/section3 Types Early, Classic, Late◦ Late• After 7 days• More devastating d/t increasedincidence of intracranial hemorrhage(~60%), permanent sequalae (~25%),mortality rate (~15%)• Associated with chronic diseases thatinterfere with fat absorption orperformance of intestinal floraB14: NEONATAL HEMATOLOGY REVIEW Page 14 of 22