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Clinical Review

ABC of clinical haematology: Haematological disorders at the extremes of life

BMJ 1997; 314 doi: (Published 26 April 1997) Cite this as: BMJ 1997;314:1262
  1. Adrian C Newland,
  2. Tyrrell G J R Evans


    Anaemia in neonates

    Common causes of anaemia in newborn infants

    • Blood loss—Occult bleeding (fetomaternal, fetoplacental, twin to twin); obstetric accidents; internal bleeding; iatrogenic

    • Increased destruction—Immune haemolytic anaemia; infection; haemoglobinopathies; enzymopathies

    • Decreased production—infection; nutritional deficiencies

    The haemoglobin concentration at birth is 159-191 g/l. It rises transiently in the first 24 hours but then slowly falls to as low as 95 g/l by 9 weeks. By 6 months, the concentration stabilises at around 125 g/l, the lower end of the adult range, increasing towards adolescence. The normal fall in haemoglobin concentration seen in full term infants is accentuated in prematurity and may fall to less than 90 g/l by 4 weeks. Preterm infants are particularly prone to multiple nutritional deficiencies because of rapid growth. Pronounced anaemia may be assumed if the infant gains insufficient weight or is fatigued while feeding.

    Haemolytic disease in newborn infants
    Recommendations for prophylactic anti-D immunoglobulin in RhD negative women

    • After delivery if the infant is Rh positive

    • After abortion (therapeutic or spontaneous)

    • To cover antenatal procedures (amniocentesis, chorionic villus sampling)

    • After threatened abortion or miscarriage

    • Antenatally at 28 and 34 weeks (not yet universal)

    Reasons for failure of prophylaxis

    • Failure of administration (commonest cause)

    • Inadequate dosage (routine Kleihauer tests should be performed)

    • Earlier sensitisation that may not be detectable at birth

    • Poor injection technique (should be deep intramuscular)

    View this table:

    Normal haematology values in newborn infants

    HIV infection

    • HIV may produce a chronic multisystem disease in children

    • Perinatal transmission of the virus from an infected woman is the primary route of exposure to the fetus (20-40% of pregnancies)

    • Thrombocytopenia occurs in up to 15% of children with HIV infection

    • Anaemia is also common, occurring early, usually with the normocytic, normochromic features of chronic disease

    • Leucopenia and lymphopenia are also seen, in which the bone marrow shows non-specific features of chronic infection

    Haemolytic disease in newborn infants is due to destruction of fetal red cells by antibodies from the mother that cross the placenta. The most important are antibodies to the …

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