Skip to main content

Anemia in the Nursery: When to Observe, When to Treat, and When to Refer

  • Chapter
  • First Online:
Common Problems in the Newborn Nursery

Abstract

Anemia is an uncommon problem in the newborn nursery and may have serious consequences when it occurs. Using a case-based method and clinical questions that confront the practitioner, common presentations of hemolytic disease, intracranial hemorrhage, acute blood loss, and infectious causes of anemia are reviewed. The chapter includes reference ranges for red cell indices in newborns, a diagnostic algorithm, recommendations for initial laboratory assessment, and indications for red blood cell transfusion. Case examples highlight recommendations for observation, evaluation, treatment, and referral.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Christensen RD, Henry E, Jopling J, Wiedmeier SE. The CBC: reference ranges for neonates. Semin Perinatol. 2009;33(1):3–11. https://doi.org/10.1053/j.semperi.2008.10.010.

    Article  PubMed  Google Scholar 

  2. Jopling J, Henry E, Wiedmeier SE, Christensen RD. Reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period: data from a multihospital health care system. Pediatrics. 2009;123(2):e333–7. https://doi.org/10.1542/peds.2008-2654.

    Article  Google Scholar 

  3. Christensen RD, Del Vecchio A, Henry E. Expected erythrocyte, platelet and neutrophil values for term and preterm neonates. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2012;25(Suppl 5):77–9. https://doi.org/10.3109/14767058.2012.715472.

    Article  Google Scholar 

  4. Christensen RD, Yaish HM, Henry E, Bennett ST. Red blood cell distribution width: reference intervals for neonates. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2015;28(8):883-8. https://doi.org/10.3109/14767058.2014.938044.

    Article  Google Scholar 

  5. Bizzarro MJ, Colson E, Ehrenkranz RA. Differential diagnosis and management of anemia in the newborn. Pediatr Clin N Am. 2004;51(4):1087–107. https://doi.org/10.1016/j.pcl.2004.03.006.

    Article  Google Scholar 

  6. Murray NA, Roberts IAG. Haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed. 2007;92(2):F83–F8. https://doi.org/10.1136/adc.2005.076794.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Maheshwari A, Carlo W. Blood Disorders. In: Nelson textbook of pediatrics [internet]. 20th ed. Philadelphia: Elsevier; 2016. p. 880–9.e1.

    Google Scholar 

  8. Mitchell S, James A. Severe late anemia of hemolytic disease of the newborn. Paediatr Child Health. 1999;4(3):201–3.

    Article  CAS  Google Scholar 

  9. Ree IMC, Smits-Wintjens V, van der Bom JG, van Klink JMM, Oepkes D, Lopriore E. Neonatal management and outcome in alloimmune hemolytic disease. Expert Rev Hematol. 2017:1–10. https://doi.org/10.1080/17474086.2017.1331124.

    Article  CAS  Google Scholar 

  10. Blanchette VS, Zipursky A. Assessment of anemia in newborn infants. Clin Perinatol. 1984;11(2):489–510.

    Article  CAS  Google Scholar 

  11. Hospital Stay for Healthy Term Newborns. Pediatrics. 2010;125(2):405.

    Article  Google Scholar 

  12. Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Births MTJ. Final data for 2015. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. 2017;66(1):1.

    Google Scholar 

  13. Ali UA, Norwitz ER. Vacuum-assisted vaginal delivery. Reviews in Obstetrics and Gynecology. 2009;2(1):5–17.

    PubMed  PubMed Central  Google Scholar 

  14. Walsh CA, Robson M, McAuliffe FM. Mode of delivery at term and adverse neonatal outcomes. Obstet Gynecol. 2013;121(1):122–8. https://doi.org/10.1097/AOG.0b013e3182749ac9.

    Article  PubMed  Google Scholar 

  15. Lubin B. Neonatal anaemia secondary to blood loss. Clin Haematol. 1978;7(1):19–34.

    CAS  PubMed  Google Scholar 

  16. Chadwick LM, Pemberton PJ, Kurinczuk JJ. Neonatal subgaleal haematoma: associated risk factors. complications and outcome Journal of paediatrics and child health. 1996;32(3):228–32.

    Article  CAS  Google Scholar 

  17. Pearson HA. Anemia in the newborn: a diagnostic approach and challenge. Seminars in Perinatology. 1991;15(3 Suppl 2):2-8.

    Google Scholar 

  18. Weiner GM, Zaichkin J, American Heart Association., American Academy of Pediatrics. Textbook of neonatal resuscitation. 2016. Available from: https://ebooks.aappublications.org/content/textbook-of-neonatal-resuscitation-nrp-7th-ed.

  19. Wylie BJ, D'Alton ME. Fetomaternal hemorrhage. Obstet Gynecol. 2010;115(5):1039–51. https://doi.org/10.1097/AOG.0b013e3181da7929.

    Article  PubMed  Google Scholar 

  20. Solomonia N, Playforth K, Reynolds EW. Fetal-maternal hemorrhage: a case and literature review. AJP Reports. 2012;2(1):7–14. https://doi.org/10.1055/s-0031-1296028.

    Article  PubMed  Google Scholar 

  21. Kleihauer E, Braun H, Betke K. Demonstration of fetal hemoglobin in erythrocytes of a blood smear. Klin Wochenschr. 1957;35(12):637–8.

    Article  CAS  Google Scholar 

  22. Bromilow IM, Duguid JK. Measurement of feto-maternal haemorrhage: a comparative study of three Kleihauer techniques and tow flow cytometry methods. Clin Lab Haematol. 1997;19(2):137–42.

    Article  CAS  Google Scholar 

  23. Dziegiel MH, Nielsen LK, Berkowicz A. Detecting fetomaternal hemorrhage by flow cytometry. Curr Opin Hematol. 2006;13(6):490–5. https://doi.org/10.1097/01.moh.0000245687.09215.c4.

    Article  PubMed  Google Scholar 

  24. Bell EF, Strauss RG, Widness JA, Mahoney LT, Mock DM, Seward VJ, et al. Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics. 2005;115(6):1685–91. https://doi.org/10.1542/peds.2004-1884.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kirpalani H, Whyte RK, Andersen C, Asztalos EV, Heddle N, Blajchman MA, et al. The premature infants in need of transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. J Pediatr. 2006;149(3):301–7. https://doi.org/10.1016/j.jpeds.2006.05.011.

    Article  PubMed  Google Scholar 

  26. Whyte R, Kirpalani H. Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants. Cochrane Database Syst Rev. 2011;11:CD000512. https://doi.org/10.1002/14651858.CD000512.pub2.

    Article  Google Scholar 

  27. Red blood cell transfusions in newborn infants. Revised guidelines. Paediatr Child Health. 2002;7(8):553–8.

    Article  Google Scholar 

  28. Alverson DC. The physiologic impact of anemia in the neonate. Clin Perinatol. 1995;22(3):609–25.

    Article  CAS  Google Scholar 

  29. Venkatesh V, Khan R, Curley A, New H, Stanworth S. How we decide when a neonate needs a transfusion. Br J Haematol. 2013;160(4):421–33. https://doi.org/10.1111/bjh.12095.

    Article  CAS  PubMed  Google Scholar 

  30. Girelli G, Antoncecchi S, Casadei AM, Del Vecchio A, Isernia P, Motta M, et al. Recommendations for transfusion therapy in neonatology. Blood Transfus. 2015;13(3):484–97. https://doi.org/10.2450/2015.0113-15.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Galel SA, Fontaine MJ. Hazards of neonatal blood transfusion. NeoReviews. 2006;7(2):e69.

    Article  Google Scholar 

  32. Ryan K, Bain BJ, Worthington D, James J, Plews D, Mason A, et al. Significant haemoglobinopathies: guidelines for screening and diagnosis. Br J Haematol. 2010;149(1):35–49. https://doi.org/10.1111/j.1365-2141.2009.08054.x.

    Article  CAS  PubMed  Google Scholar 

  33. Shalev H, Moser A, Kapelushnik J, Karplus M, Zucker N, Yaniv I, et al. Congenital dyserythropoietic anemia type I presenting as persistent pulmonary hypertension of the newborn. J Pediatr. 2000;136(4):553–5.

    Article  CAS  Google Scholar 

  34. Sieff CA, Nisbet-Brown E, Nathan DG. Congenital bone marrow failure syndromes. Br J Haematol. 2000;111(1):30–42. https://doi.org/10.1111/j.1365-2141.2000.02263.x.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emily A. Morris MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Morris, E.A., Stark, A.R. (2019). Anemia in the Nursery: When to Observe, When to Treat, and When to Refer. In: Martin, G., Rosenfeld, W. (eds) Common Problems in the Newborn Nursery. Springer, Cham. https://doi.org/10.1007/978-3-319-95672-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-95672-5_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-95671-8

  • Online ISBN: 978-3-319-95672-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics