Anemia of Prematurity - Portal Neonatal

o Arterial blood gases (ABG): Consider measuring ABG values to assess oxygenation
in the symptomatic infant.
o Platelet count: This count may demonstrate thrombocytopenia if thrombosis or DIC
are present.
TREATMENT Section 6 of 9
Medical Care: Therapy is based on both the measured central venous Hct and the presence or
absence of symptoms.
Treatment of polycythemia with partial exchange transfusion remains controversial. Regarding
treatment with partial exchange, the Committee of the Fetus and Newborn of the American Academy
of Pediatrics states, "The accepted treatment of polycythemia is partial exchange transfusion (PET).
However there is no evidence that exchange transfusion affects the long term outcome."
• Treatment for asymptomatic patients
o Hct 65-75%: Liberally give fluids, perform cardiorespiratory monitoring and monitoring of
Hct and glucose levels every 6 hours, and observe the patient for symptoms.
o Hct >75% on repeated measurements: Consider partial exchange transfusion.
o If the etiology is dehydration: Rehydrate the patient over 6-8 hours.
• Treatment for symptomatic patients
o Hct 60-65%: Consider alternative explanations for the symptoms. Although hyperviscosity
may be the etiology of the symptoms, other causes for the symptoms must be excluded.
o Hct >65% with symptoms attributable to hyperviscosity: Perform partial exchange
transfusion.
• Partial exchange transfusion
o Perform a partial exchange transfusion by using an umbilical arterial or venous catheter to
reduce the central Hct to 50-55%.
o The total blood volume to be exchanged is determined as follows: [blood volume(patient's
Hct – desired Hct)]/(patient's Hct), where blood volume = the patient's weight in kilograms
multiplied by 90 mL/kg.
o Normal saline is the replacement fluid of choice for exchange transfusions because it is
effective and inexpensive. As alternatives, Plasmanate, 5% albumin, or fresh frozen
plasma can be used. However, none of these is more effective than normal saline. In
addition, both 5% albumin and fresh frozen plasma are blood products, and certain
religious beliefs prohibit their use.
o Sterile technique is required.
o An exchange transfusion can be performed in 3 ways, depending on the type of vascular
access that is available. Regardless of the method used, aliquots should not exceed
approximately 5 mL/kg delivered or removed over 2-3 minutes.
� If only a single umbilical arterial or venous catheter is in place, use a push-pull
technique. With this technique, the withdrawal of blood is alternated with the
administration of replacement fluid through the single catheter. Do not remove more
than 5% of the patient's calculated blood volume in any single withdrawal.
� If both umbilical venous and arterial catheters are in place, withdraw blood from the
arterial catheter while administering the replacement fluid through the venous catheter
� If a venous or arterial umbilical catheter and a peripheral venous catheter are in place,
the former can be used for blood withdrawal, while the latter is used to simultaneously
and continuously infuse the replacement fluid.