Advertisement

Tijdschrift voor kindergeneeskunde

, Volume 73, Issue 2, pp 215–219 | Cite as

Neonatale polycytemie: voorbeelden uit de praktijk en overzicht van de literatuur

  • I. A. Zonnenberg
  • B. A. Semmekrot
Casuïstische mededelingen
  • 63 Downloads

Samenvatting

Neonatale polycytemie wordt gedefinieerd als een complex van symptomen in combinatie met een veneuze hematocriet boven 65%. De incidentie wordt opgegeven als 1-5% van alle pasgeborenen. De pathofysiologie wordt gekenmerkt door toename van het aantal erytrocyten, met toename van bloedviscositeit en vermindering van orgaanperfusie, leidend tot een diversiteit aan symptomen. Diverse met neonatale polycytemie geassocieerde factoren passeren de revue. Aangezien de hematocriet in de eerste uren na de geboorte toeneemt, zijn de symptomen vaak nog niet direct na de geboorte aanwezig, maar ontstaan ze pas in de daaropvolgende uren. Richtlijnen om een partiële wisseltransfusie te verrichten zijn een hematocriet van meer dan 70%, zonder symptomen, of tussen 65-70%, met symptomen. Bij voorkeur worden tegenwoordig kristallijne oplossingen gebruikt voor partiële wisseltransfusie, waarbij doorgaans de symptomen direct verminderen. We rapporteren acht polycytemische pasgeborenen met diverse predisponerende factoren, die zich presenteerden met symptomen van relatieve hypoxie en beschrijven een symptomatisch indexkind waarbij de symptomen verdwenen na partiële wisseltransfusie. Tevens bespreken we de literatuur over het onderwerp. Wij adviseren bij een pasgeborene die zich presenteert met symptomen van mogelijke polycytemie de hematocriet te bepalen en bij bevestiging van de diagnose direct een partiële wisseltransfusie met fysiologisch zout te verrichten.

Summary

Neonatal polycythaemia is defined as a complex of symptoms in association with a venous haematocrit higher than 65%. The incidence is reported as 1-5% of all neonates. The pathophysiology is characterised by an increased number of red blood cells resulting in increased blood viscosity causing malperfusion of various organs, with a diversity of symptoms. Several factors, known to be associated with neonatal polycythaemia, will be discussed. Haematocrit rises in the first hours after birth, explaining why symptoms may not be present directly after birth, but become severe a couple of hours after birth. As guidelines to perform a partial plasma exchange transfusion a haematocrit of more than 70%, without symptoms, or between 65-70%, with symptoms, can be used. Crystalloids are now preferred for partial plasma exchange transfusion, usually causing direct relief of symptoms. We report data of eight newborn infants with polycythaemia in the presence of various predisposing factors, presenting with symptoms of relative hypoxia. A symptomatic index case is described, in which symptoms disappeared after partial plasma exchange transfusion. The literature on the subject is discussed. If a newborn infant presents with symptoms consistent with possible polycythaemia, we advise to determine the haematocrit and, if polycythaemia is diagnosed, perform a physiologic saline partial plasma exchange transfusion without delay.

Literatuur

  1. Avery GB, Fletcher MA, MacDonald MG. Neonatology, pathophysiology and management of the newborn, 5th ed. Philadelphia: Lippincott Williams & 38; Wilkins, 1999.Google Scholar
  2. Bada HS, Korone SB, Pourcyrous M, et al. Asymptomatic syndrome of polycythemic hyperviscosity: effect of partial plasma exchange transfusion. J Pediatr 1992;120:579-85.CrossRefPubMedGoogle Scholar
  3. Behrman RE, Kliegman RM, Jenson HB. Nelson textbook of pediatrics, 16th ed. Philadelphia: Saunders, 2000.Google Scholar
  4. Cloherty JP, Stark AR. Manual of neonatal care, 4th ed. Philadelphia: Lippincott Williams & 38; Wilkins, 1998.Google Scholar
  5. Delany-Black V, Camp BW, Lubchenco LO, et al. Neonatal hyperviscosity association with lower achievement and IQ scores at school age. Pediatrics 1989;83:662-7.Google Scholar
  6. Deorari AK, Paul VK, Shreshta L, Singh M. Symptomatic neonatal polycythemia: comparison of partial exchange transfusion with saline versus plasma. Indian Pediatr 1995;32:1167-71.PubMedGoogle Scholar
  7. Derksen-Lubsen G, Moll HA, Büller HA. Compendium pediatrics, 2e druk. Houten: Bohn Stafleu van Loghum, 2000.Google Scholar
  8. Fanaroff AA, Martin RJ. Neonatal-perinatal medicine. Diseases of the fetus and infant, 4th ed. St. Louis: Mosby, 1992.Google Scholar
  9. International Guidelines for Neonatal Resuscitation. An excerpt from the guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care: International Consensus Science. Pediatrics 2000;106:1–16 (http://www.pediatrics.org/cgi/content/full/106/3/e29).Google Scholar
  10. Krishnan L, Rahim A. Neonatal polycythemia. Indian J Pediatr 1997;64:541-6.CrossRefPubMedGoogle Scholar
  11. Levy I, Merlob P, Ashkenazi S, Reisner SH. Neonatal polycythaemia: effect of partial dilutional exchange transfusion with human albumin on whole blood viscosity. Eur J Pediatr 1990;49:354-5.CrossRefGoogle Scholar
  12. Linderkamp O. Blood rheology in the newborn infant. Baillieres Clin Haematol 1987;1:801-25.CrossRefPubMedGoogle Scholar
  13. Maertzdorf WJ. Neonatal polycythaemia: clinical symptoms, and disturbances in blood flow, velocity and haemorheology. Academisch Proefschrift, Universiteit van Maastricht, 1992.Google Scholar
  14. Maertzdorf WJ, Aldenhuyzen-Dorland W, Slaaf DW, et al. Circulating blood volume in appropriate and small for gestational age full term and preterm polycythaemic infants. Acta Paediatr Scand 1991;80:620-7.CrossRefPubMedGoogle Scholar
  15. Maertzdorf WJ, Tangelder GJ, Slaaf DW, Blanco CE. Effects of partial plasma exchange transfusion on cerebral blood flow velocity in polycythaemic preterm, term and small for date newborn infants. Eur J Pediatr 1989;148:774-8.CrossRefPubMedGoogle Scholar
  16. Maerztdorf WJ, Tangelder GJ, Slaaf DW, Blanco CE. Effects of partial plasma exchange transfusion on blood flow velocity in large arteries of arm and leg, and cerebral arteries in polycythaemic newborn infants. Acta Paediatr 1993;82:12-8.CrossRefGoogle Scholar
  17. Merchant RH, Phadke SD, Sakhalkar VS, et al. Hematocrit and whole blood viscosity in newborns: analysis of 100 cases. Indian Pediatr 1992;29:555-61.PubMedGoogle Scholar
  18. Norman M, Fagrell B, Herin P. Effects of neonatal polycythemia and hemodilution on capillary perfusion. J Pediatr 1992; 121:103-8.CrossRefPubMedGoogle Scholar
  19. Norman M, Fagrell B, Herin P. Skin microcirculation in neonatal polycythaemia and effects of haemodilution. Interaction between haematocrit, vasomotor activity and perfusion. Acta Paediatr 1993;82:672-7.PubMedGoogle Scholar
  20. Ratrisawadi V, Plubrukarn R, Trakulchang K, Puapondh Y. Developmental outcome of infants with neonatal polycythemia. J Med Assoc Thai 1994;77:76-80.PubMedGoogle Scholar
  21. Roithmaier A, Arlettaz R, Bauer K, et al. Randomized controlled trial of Ringer solution versus serum for partial exchange transfusion in neonatal polycythemia. Eur J Pediatr 1995;154:53-6.CrossRefPubMedGoogle Scholar
  22. Singh S, Narang A, Bhakoo ON. Polycythemia of the newborn. Indian Pediatr 1990;27: 349-52.PubMedGoogle Scholar
  23. Taeusch HW, Ballard RA, Avery ME. Diseases of the newborn, 6th ed. Philadelphia: Saunders, 1991.Google Scholar
  24. Werner EJ. Neonatal polycythemia and hyperviscosity. Clin Perinatal 1995;22:693-710.Google Scholar
  25. Wong W, Fok TF, Lee CH, et al. Randomised controlled trail: comparison of colloid or crystalloid for partial exchange transfusion for treatment of neonatal polycythaemia. Arch Dis Child 1997;77:115-8.CrossRefGoogle Scholar

Copyright information

© Bohn Stafleu van Loghum 2005

Authors and Affiliations

  1. 1.

Personalised recommendations