Polycythemia of the Newborn Differential Diagnoses
- Author: Karen J Lessaris, MD; Chief Editor: Ted Rosenkrantz, MD more...
Use of a blood product (eg, albumin) in an exchange transfusion may result in the transmission of infection. Infections related to blood products can be avoided by using normal saline, which is sterile and which has been shown to be as effective as albumin.
Informed consent must be obtained as exchange transfusions have multiple risks (see Treatment).
Umbilical partial exchange transfusion increases risk of necrotizing enterocolitis (NEC), especially if colloid is used.
No improvement in neurologic outcomes has been reported with partial exchange transfusion. However, polycythemia and neurologic abnormalities have been linked. Because of this, a symptomatic infant who has not been treated with partial exchange transfusion, and who subsequently develops neurologic abnormalities, may be considered inadequately treated.
Other problems to be considered
Method of blood draw
Capillary hematocrit (Hct) measurements depend on regional blood flow and can widely vary from central venous measurements, generally overestimating the central or true Hct level.
These may be related to transfusion or practice of delayed cord clamping.
Jeevasankar M, Agarwal R, Paul VK, et al. Polycythemia in the newborn. Indian J Pediatr. January 2008. 75(1):68-73.
Mimouni FB, Merlob P, Dollberg S, Mandel D. Neonatal polycythaemia: critical review and a consensus statement of the Israeli Neonatology Association. Acta Paediatr. 2011 Oct. 100(10):1290-6. [Medline].
Vlug RD, Lopriore E, Janssen M, et al. Thrombocytopenia in neonates with polycythemia: incidence, risk factors and clinical outcome. Expert Rev Hematol. 2015 Feb. 8 (1):123-9. [Medline].
Rincon D, Foguet A, Rojas M, et al. [Time of cord clamping and neonatal complications, a prospective study]. An Pediatr (Barc). 2014 Sep. 81(3):142-8. [Medline].
Andersson O, Hellstrom-Westas L, Andersson D, et al. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011 Nov 15. 343:d7157. [Medline]. [Full Text].
Sainz JA, Romero C, García-Mejido J, Soto F, Turmo E. Analysis of middle cerebral artery peak systolic velocity in monochorionic twin pregnancies as a method for identifying spontaneous twin anaemia-polycythaemia sequence. J Matern Fetal Neonatal Med. 2014 Jul. 27 (11):1174-6. [Medline].
Veujoz M, Sananès N, Severac F, et al. Evaluation of prenatal and postnatal diagnostic criteria for twin anemia-polycythemia sequence. Prenat Diagn. 2015 Mar. 35 (3):281-8. [Medline].
Sankar MJ, Agarwal R, Deorari A, Paul VK. Management of polycythemia in neonates. Indian J Pediatr. 2010 Oct. 77(10):1117-21. [Medline].
[Guideline] AAP. American Academy of Pediatrics Committee on Fetus and Newborn: routine evaluation of blood pressure, hematocrit, and glucose in newborns. Pediatrics. 1993 Sep. 92(3):474-6. [Medline].
Morag I, Strauss T, Lubin D, Schushan-Eisen I, Kenet G, Kuint J. Restrictive management of neonatal polycythemia. Am J Perinatol. 2011 Oct. 28(9):677-82. [Medline].
Awonusonu FO, Pauly TH, Hutchison AA. Maternal smoking and partial exchange transfusion for neonatal polycythemia. Am J Perinatol. 2002 Oct. 19(7):349-54. [Medline].
Dempsey EM, Barrington K. Short and long term outcomes following partial exchange transfusion in the polycythaemic newborn: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2006 Jan. 91(1):F2-6. [Medline].
Drew JH, Guaran RL, Grauer S, Hobbs JB. Cord whole blood hyperviscosity: measurement, definition, incidence and clinical features. J Paediatr Child Health. 1991 Dec. 27(6):363-5. [Medline].
Pappas A, Delaney-Black V. Differential diagnosis and management of polycythemia. Pediatr Clin North Am. 2004 Aug. 51(4):1063-86, x-xi. [Medline].
Rosenkrantz TS. Polycythemia and hyperviscosity in the newborn. Semin Thromb Hemost. 2003 Oct. 29(5):515-27. [Medline].
Schimmel MS, Bromiker R, Soll RF. Neonatal polycythemia: is partial exchange transfusion justified?. Clin Perinatol. 2004 Sep. 31(3):545-53, ix-x. [Medline].
Shohat M, Reisner SH, Mimouni F, Merlob P. Neonatal polycythemia: II Definition related to time of sampling. Pediatrics. 1984 Jan. 73(1):11-3. [Medline].
Werner EJ. Neonatal polycythemia and hyperviscosity. Clin Perinatol. 1995 Sep. 22(3):693-710. [Medline].
Wirth FH, Goldberg KE, Lubchenco LO. Neonatal hyperviscosity: I. Incidence. Pediatrics. 1979 Jun. 63(6):833-6. [Medline].
Wong W, Fok TF, Lee CH, et al. Randomised controlled trial: comparison of colloid or crystalloid for partial exchange transfusion for treatment of neonatal polycythaemia. Arch Dis Child Fetal Neonatal Ed. 1997 Sep. 77(2):F115-8. [Medline].
Watchko JF. Common hematologic problems in the newborn nursery. Pediatr Clin North Am. 2015 Apr. 62 (2):509-24. [Medline].
Taniguchi K, Sumie M, Sugibayashi R, Wada S, Matsuoka K, Sago H. Twin anemia-polycythemia sequence after laser surgery for twin-twin transfusion syndrome and maternal morbidity. Fetal Diagn Ther. 2015. 37 (2):148-53. [Medline].