Anemia of Prematurity - Portal Neonatal

Causes:
• AOP results from a combination of relatively diminished RBC production, shortened RBC life
span, and blood loss.
• Nutritional deficiencies of vitamin E, vitamin B-12, and folate may exaggerate the degree of
anemia.
DIFFERENTIALS Section 4 of 10
Anemia, Acute
Anemia, Chronic
Birth Trauma
Head Trauma
Hemolytic Disease of Newborn
Parvovirus B19 Infection
Periventricular Hemorrhage-Intraventricular Hemorrhage
Other Problems to be Considered:
Bone marrow infiltration Diamond-Blackfan anemia
Disseminated intravascular coagulation Elliptocytosis
G-6-PD deficiency GI bleeding
Glucose kinase deficiency Immune-mediated hemolysis
Iron deficiency Pancytopenia
Spherocytosis Twin-to-twin transfusion syndrome
Vitamin E deficiency
Lab Studies:
WORKUP Section 5 of 10
• Complete blood count
o The CBC demonstrates normal white blood cell (WBC) and platelet lines.
o The hemoglobin is less than 10 g/dL but may descend to a nadir of 6-7 g/dL; the
lowest levels generally are observed in the smallest infants.
o RBC indices are normal (eg, normochromic, normocytic) for age.
• Reticulocyte count
o The reticulocyte count is low when the degree of anemia is considered as a result of
the low levels of EPO.
o The finding of an elevated reticulocyte count is not consistent with the diagnosis of
AOP.
• Peripheral blood smear: No abnormal forms are observed.
• Maternal and infant blood typing: In the evaluation of anemia, consider the possibility of
hemolytic processes, such as the ABO blood group system and Rh incompatibility.
• Direct antibody test (Coombs): This test may be coincidentally positive; however, with such a
finding, ensure that an immune-mediated hemolytic process is not ongoing.
• Serum bilirubin: With an elevated serum bilirubin level, consider other possible explanations
for the anemia.