What are the symptoms of polycythemia in newborns. How is polycythemia detected in babies. What causes high red blood cell count in newborns. How is polycythemia treated in infants. What are the long-term effects of polycythemia in newborns.

Understanding Polycythemia and Hyperviscosity in Newborns

Polycythemia is a condition characterized by an abnormally high concentration of red blood cells in a newborn’s blood. This excess of red blood cells leads to a thickening of the blood, known as hyperviscosity. As a result, blood circulation slows down, potentially depriving organs of sufficient oxygen.

To better understand this condition, let’s explore its key aspects:

• Polycythemia is the opposite of anemia
• It causes blood to become thicker than normal
• Thickened blood travels more slowly through the body
• Some organs may not receive enough oxygen due to hyperviscosity

Causes of Polycythemia in Newborns

Several factors can contribute to the development of polycythemia in newborns. Understanding these causes is crucial for proper diagnosis and treatment. Here are the main reasons:

1. Overproduction of red blood cells by the baby’s body
2. Transfer of extra red blood cells from another source, such as a twin during pregnancy
3. Delayed cord clamping after birth, allowing too many red blood cells to travel from the umbilical cord to the baby

Can maternal factors contribute to polycythemia in newborns? While not mentioned in the original text, research suggests that maternal diabetes, hypertension, or living at high altitudes can increase the risk of polycythemia in infants.

Recognizing the Signs and Symptoms of Polycythemia

Identifying polycythemia in newborns can be challenging, as many affected babies may not display obvious symptoms. However, there are some signs to watch for:

• Reddish skin, especially when crying
• Bluish color around the lips (cyanosis)
• Temporary breathing pauses (apnea)
• Poor feeding
• Low blood sugar (hypoglycemia)

Are these symptoms always indicative of polycythemia? Not necessarily. These signs can be associated with other neonatal conditions, which is why proper medical evaluation is crucial for an accurate diagnosis.

Diagnostic Procedures for Polycythemia in Newborns

Detecting polycythemia requires careful medical assessment and specific diagnostic tests. The primary method for diagnosis is:

• A blood test to measure the hematocrit level (percentage of red blood cells in the blood)

If the hematocrit level is elevated, healthcare providers may conduct additional blood tests to rule out other conditions that could cause high red blood cell counts.

How is the hematocrit test performed in newborns? Typically, a small blood sample is taken from the baby’s heel or a vein. The sample is then analyzed in a laboratory to determine the proportion of red blood cells.

Treatment Options for Neonatal Polycythemia

The treatment approach for polycythemia in newborns depends on the severity of the condition and the presence of symptoms. Treatment options may include:

1. Observation and monitoring
2. Ensuring adequate fluid intake and maintaining normal blood sugar levels
3. Intravenous (IV) fluid administration for more severe cases
4. Partial exchange transfusion in the most severe instances

What is a partial exchange transfusion? This procedure involves removing a portion of the baby’s blood and replacing it with intravenous fluids. This effectively dilutes the blood, reducing the concentration of red blood cells.

Monitoring and Conservative Management

For mild cases of polycythemia, healthcare providers may opt for a conservative approach:

• Regular monitoring of the baby’s condition
• Ensuring proper hydration
• Maintaining normal glucose levels
• Periodic retesting to track hematocrit levels

Intravenous Fluid Therapy

In more severe cases, intravenous fluids may be administered to help dilute the blood and improve circulation. This approach can help alleviate symptoms and reduce the risk of complications associated with hyperviscosity.

Partial Exchange Transfusion

For the most severe cases of polycythemia, a partial exchange transfusion may be necessary. This procedure involves:

1. Removing a portion of the baby’s blood
2. Replacing it with intravenous fluids
3. Diluting the remaining blood to reduce red blood cell concentration

How effective is partial exchange transfusion in treating polycythemia? While this procedure can rapidly normalize hematocrit levels, its long-term benefits and potential risks are still subjects of ongoing research in neonatal medicine.

Long-term Prognosis and Potential Complications

In most cases, polycythemia in newborns has no lasting effects. However, there are some considerations to keep in mind:

• Temporary jaundice may occur as excess red blood cells break down
• In rare cases, complications such as blood clots (thrombi) may develop
• Very uncommon complications could include stroke or organ damage

Do all babies with polycythemia experience long-term effects? Fortunately, the majority of infants with polycythemia recover fully without any lasting complications. However, close follow-up with healthcare providers is essential to monitor the baby’s progress and address any potential issues promptly.

Preventive Measures and Risk Factors

While not all cases of polycythemia can be prevented, understanding risk factors and taking appropriate measures can help reduce the likelihood of its occurrence:

• Proper management of maternal conditions such as diabetes and hypertension during pregnancy
• Careful consideration of cord clamping timing during delivery
• Regular prenatal care to identify potential risk factors

Can delayed cord clamping increase the risk of polycythemia? While delayed cord clamping has numerous benefits, such as improved iron stores in infants, excessive delay may contribute to polycythemia in some cases. Healthcare providers typically balance the benefits and risks when deciding on cord clamping timing.

Maternal Risk Factors

Several maternal conditions can increase the risk of polycythemia in newborns:

1. Gestational diabetes
2. Hypertension during pregnancy
3. Living at high altitudes
4. Maternal smoking

Fetal and Neonatal Risk Factors

Certain factors related to the fetus or newborn can also contribute to the development of polycythemia:

• Twin-to-twin transfusion syndrome in multiple pregnancies
• Intrauterine growth restriction
• Certain genetic disorders

Importance of Follow-up Care for Infants with Polycythemia

After initial treatment and stabilization, ongoing care and monitoring are crucial for infants who have experienced polycythemia. Follow-up care typically involves:

1. Regular check-ups with a pediatrician
2. Monitoring of growth and development
3. Periodic blood tests to ensure normal hematocrit levels
4. Assessment of neurological function

How long should follow-up care continue for infants with polycythemia? The duration of follow-up care can vary depending on the severity of the initial condition and the presence of any complications. In most cases, pediatricians will continue monitoring until they are confident that the child has fully recovered and is developing normally.

Developmental Monitoring

While most infants with polycythemia develop normally, healthcare providers may pay special attention to:

• Motor skill development
• Cognitive function
• Speech and language development
• Social and emotional growth

Long-term Health Considerations

Although rare, some infants who experienced severe polycythemia may require ongoing monitoring for potential long-term effects:

1. Cardiovascular health
2. Renal function
3. Neurological development

Is there a need for special interventions for children who had polycythemia as newborns? In most cases, no specific interventions are necessary beyond regular pediatric care. However, if any developmental concerns arise, early intervention and appropriate therapies can be beneficial.

Advancements in Neonatal Care for Polycythemia

The field of neonatal medicine continues to evolve, bringing new insights and improved care for infants with polycythemia. Recent advancements include:

• More accurate and less invasive diagnostic techniques
• Refined treatment protocols based on evidence-based medicine
• Improved understanding of long-term outcomes
• Enhanced prenatal screening for risk factors

How have these advancements impacted the management of polycythemia in newborns? These developments have led to more personalized and targeted approaches to treatment, potentially reducing the need for invasive interventions and improving overall outcomes for affected infants.

Research Directions

Ongoing research in neonatal polycythemia focuses on several key areas:

1. Identifying genetic markers associated with increased risk
2. Developing non-invasive monitoring techniques
3. Investigating the long-term neurodevelopmental outcomes
4. Exploring novel treatment approaches with fewer side effects

Future Prospects

As our understanding of neonatal polycythemia continues to grow, we can anticipate:

• More precise risk assessment tools
• Tailored prevention strategies for high-risk pregnancies
• Advanced treatment options with minimal invasiveness
• Improved long-term follow-up protocols

What role might emerging technologies play in the management of neonatal polycythemia? Advancements in areas such as artificial intelligence and point-of-care diagnostics could potentially revolutionize how we detect, monitor, and treat polycythemia in newborns, leading to even better outcomes in the future.

Polycythemia and Hyperviscosity in the Newborn

Red blood cells carry oxygen in the
blood. Polycythemia occurs when a baby’s blood has more red cells than normal. It’s
the
opposite of anemia, which is caused by too few red cells. The extra red cells make
the
blood thicker. When blood is too thick, it travels through the body more slowly than
normal. This problem is called hyperviscosity. As a result, some organs may not get
enough
oxygen.

What causes polycythemia?

The problem may be caused by one of
the following:

• The baby’s body makes more
  red blood cells than it should.

• The baby got extra red blood
  cells from another source, such as from a twin during pregnancy.

• Just after birth, too many
  red blood cells traveled from the umbilical cord to the baby before the cord was
  clamped.

How is polycythemia detected?

Most babies with polycythemia don’t
look any different from normal. But a baby with this condition may have skin that
looks
red, especially while the baby is crying. This is often the first sign of a problem.
The
baby may also have a bluish color around their lips (cyanosis). The baby may also
temporarily stop breathing (apnea), not feed well, or have low blood sugar
(hypoglycemia).

A blood test (hematocrit) is done
to measure the level of red blood cells. If the number is too high, your baby may
need
treatment. The healthcare provider will likely also do other blood tests to make sure
the higher level of hematocrit is not caused by another condition.

How is polycythemia treated?

• Treatment will depend on the
  level of red blood cells (hematocrit), as well as symptoms your baby has.

• Treatment may include
  observing your baby, giving them a normal amount of fluids and sugar (glucose),
  and periodic retesting.

• More severe cases may be
  treated with IV (intravenous) fluids.

• Treatment in the most severe
  cases may involve removing some of the baby’s blood and replacing it with fluid
  through an IV line. This waters down (dilutes) the blood, so red blood cells are
  less concentrated. This treatment is called a partial exchange transfusion.

What are the long-term effects?

In most cases, polycythemia has no
lasting effects. As the extra red blood cells break down, the baby will probably
have yellowing of the skin (jaundice) for a short time. This is normal. If a blood
clot
(thrombus) or other problems occurred because of hyperviscosity, the baby may have
complications. These could include stroke or organ damage. But these are very uncommon.
Talk with the healthcare provider about how your baby is likely to progress.

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Why is hemoglobin elevated and what to do about it

July 8, 2021

Likbez

Health

Sometimes this is normal, but most likely you will have to go to the doctor.

You can listen to the article. If it’s more convenient for you, turn on the podcast.

Hemoglobin is a pigment protein found in red blood cells. It contains iron ions, to which oxygen atoms are attached as a result of an oxidation reaction. Hemoglobin carries them to the tissues and thus ensures the respiration of cells.

Normal hemoglobin levels depend on sex. In women it is 123–153 g/l, and in men it is 140–175 g/l. An increase in the amount of this protein may be a sign of disease or a consequence of the influence of certain factors.

Smoking

Doctors often notice an increase in hemoglobin in smokers. This is due to the fact that tobacco smoke acts like carbon monoxide and attaches to hemoglobin instead of oxygen, so the latter in the blood becomes less. To compensate for these losses, the body is forced to produce more new hemoglobin.

What to do

Quit smoking.

Being in the mountains

Above 2,400 m above sea level, the air is very rarefied and contains little oxygen. Therefore, unprepared people during the ascent develop acute mountain sickness, which without medical assistance can lead to death. Complications can be avoided if you live at a height for some time. Then the body will adapt to the new conditions, and the level of hemoglobin in the blood will increase. The same process is observed in those who constantly live in the mountains.

What to do

This adaptive response is essential for survival. Therefore, nothing needs to be done.

Dehydration

Vomiting, diarrhea, heavy sweating, frequent urination or lack of water in the body causes dehydration. Because of this, the blood thickens, becomes more concentrated. As a result, hemoglobin levels rise.

What to do

We need to fill the water deficit. For mild dehydration, simply drink plenty of water. In more serious situations, rehydration solutions are also used. They contain salts that help retain fluid in the body. And in severe cases, patients are given droppers.

Medication effects

Medicines containing erythropoietin or synthetic testosterone may increase hemoglobin and red blood cell count. These drugs stimulate cell division in the bone marrow.

What to do

Usually nothing needs to be done, the effect will disappear when the person stops taking these drugs.

Chronic obstructive pulmonary disease

Pathology develops in chronic bronchitis or pulmonary emphysema. With obstructive disease, the bronchi are blocked and the outflow of air is difficult. As a result, gas exchange is disturbed, and red blood cells cannot be saturated with oxygen, so the body increases the synthesis of hemoglobin.

What to do

The underlying disease needs to be treated. Doctors usually recommend quitting smoking, changing jobs, if the workplace has to deal with a lot of dust or dangerous gases. Medications are also prescribed to help expand the bronchi, improve gas exchange in the lungs, and reduce inflammation. Sometimes antibiotics are used.

Some people have to breathe oxygen through a mask, and in severe cases even undergo a lung transplant or have pathological tissue removed.

Heart disease

In humans, hemoglobin may increase with heart failure. This is a condition in which the heart is unable to perform its normal function. Therefore, less blood and oxygen enters the tissues, and the body tries to make up for the deficiency. The following pathologies lead to this condition:

• heart attack and coronary heart disease;
• high blood pressure;
• damage to heart valves;
• cardiomyopathy – damage to the heart muscle;
• myocarditis – inflammation of the heart muscle;
• arrhythmia;
• congenital heart disease;
• other diseases that can affect the cardiovascular system, such as hyperthyroidism, hypothyroidism, HIV, diabetes mellitus.

What to do

It is necessary to treat a disease that led to heart failure and an increase in hemoglobin. Doctors usually prescribe medication, but malformations may require surgery.

Polycythemia vera

This is a form of blood cancer in which the bone marrow produces too many red blood cells, which causes an increase in hemoglobin. The disease is rare and usually occurs in people 50–75 years of age.

What to do

If a doctor suspects polycythemia after a blood test, they will refer the person to a hematologist. This specialist will prescribe medication or perform a phlebotomy or bloodletting. It is done to reduce the number of red blood cells and hemoglobin. The procedure is repeated every three months.

Kidney cancer

Sometimes elevated hemoglobin is one of the signs of kidney cancer. In this organ, the hormone erythropoietin is synthesized, which stimulates the division of red blood cells. And with a tumor, the hormone becomes more.

What to do

You need to contact a general practitioner who, if a tumor is suspected, will refer you to an oncologist. If the diagnosis is confirmed, surgery will be required.

Liver cancer

High hemoglobin levels may be associated with impaired liver function. Due to the failure, the ratio of direct and indirect bilirubin changes. It is possible that the body reacts to this and enhances the synthesis of hemoglobin.

What to do

If a tumor of the internal organs is suspected, the general practitioner will refer the person to an oncologist. The latter will decide which operation to perform and whether follow-up radiation and chemotherapy is needed.

Read also 🩸

• How to decipher a biochemical blood test: the norm of indicators
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• How to recognize a lack of hemoglobin and increase it
• What tests and vaccinations are needed at different periods of life
• What does low hemoglobin mean and what to do about it

Clinical blood test with leukocyte formula

General (clinical) blood test with the formula is the main laboratory test most often prescribed for any pathological process. A blood test with a formula includes determining the number of all blood cells (erythrocytes, leukocytes, platelets), determining the content of hemoglobin, hematocrit, erythrocyte indicators (MCV, MCH, MCHC).

In what cases is a formula CBC test usually ordered?

This study is prescribed, in preparation for hospitalization and planned surgical interventions, with annual medical examinations, repeatedly during pregnancy, in children before any vaccination.

For any disease, a general blood test with a leukocyte formula is a study that provides the necessary information about the current condition of the patient. The presence of anemia and hematological diseases, the severity of inflammation and the response of the body’s immune system, indicators of the allergic process and possible signs of helminthic invasion – this information can be obtained from a clinical blood test with a formula.

What exactly is determined in the process of analysis?

Erythrocytes (RBC, red blood cells, “red blood cells”) – non-nuclear blood cells containing hemoglobin. The shape of erythrocytes in the form of a biconcave disk provides an increase in their surface area and an increase in the possibilities of gas exchange; gives plasticity when passing through the capillaries. The main function of erythrocytes is to transport oxygen from the lungs to tissues and carbon dioxide from tissues to the lungs. Determination of the number of erythrocytes is of the most important diagnostic value in the diagnosis of anemia in combination with the determination of hemoglobin, hematocrit, erythrocyte indices.

Hemoglobin (Hb, HGB, hemoglobin) is the main component of erythrocytes, the structure consists of protein (globin) and iron (heme), the main function is the transport of oxygen and carbon dioxide and their exchange between the lungs and tissues of the body. The level of hemoglobin depends on gender, age, altitude above sea level (inhabitants of high mountains have higher hemoglobin), smoking. Hemoglobin is measured in grams per 1 ml of blood, therefore, when assessing the level of hemoglobin, you need to pay attention to hematocrit. An increase in hematocrit (usually associated with dehydration) can falsely increase the concentration of hemoglobin.

Hematocrit (Ht, Hematocrit) – the percentage of red blood cells in the total blood volume, reflects hemoconcentration. The determination of hematocrit is used to assess the degree of anemia, the calculation of erythrocyte indices. Changes in hematocrit do not always correlate with changes in the total number of red blood cells, so the hematocrit value is difficult to interpret immediately after acute blood loss or blood transfusion.

MCV (Mean Cell volume) – the average volume of an erythrocyte, a calculated indicator. The mean volume of an erythrocyte is used in the differential diagnosis of anemia. According to the MCV value, normocytic anemias are distinguished (MCV 80-100 fl in adults and children from 5 years old), microcytic (MCV less than 80 fl) and macrocytic (more than 100 fl). In the presence of erythrocytes of different shapes (anisocytosis) or a large number of erythrocytes with an altered form, MCV may not be informative enough.

MCH (Mean Cell Hemoglobin) – the average content of hemoglobin in an erythrocyte (in 1 cell). The calculated indicator, according to the clinical value of the MSI, is similar to the color indicator, but is more reliable, and is calculated in absolute units (pg). Used in the differential diagnosis of anemia. Based on the MSI index, normochromic, hypochromic and hyperchromic anemias are distinguished.

MCHC (Mean Cell Hemoglobin Concentration) – the average concentration of hemoglobin in red blood cells. An indicator of the degree of saturation of an erythrocyte with hemoglobin. This is a concentration index that does not depend on cell volume. MCHC is a sensitive indicator reflecting changes in hemoglobin formation; relevant in the diagnosis of iron deficiency anemia, thalassemia, some types of hemoglobinopathies.

Rel. red cell distribution width (RDW, Red cell Distribution Width) – a measure of the difference in red blood cells by volume. In the blood of a healthy person, erythrocytes differ slightly, and the RDW indicator borders within 12-15%. RDW above normal reflects the heterogeneity (heterogeneity) of erythrocytes (degree of anisocytosis). Used in the differential diagnosis and monitoring of anemia treatment.

Platelets (PLT, Platelets) are blood cells involved in clotting. They are non-nuclear cytoplasmic fragments of their predecessors – megakaryocytes formed in the bone marrow. The average lifespan in the bloodstream is 10 days. In a calm state, platelets have a disc-shaped shape, when activated, they become spherical and form special outgrowths – pseudopodia, thanks to which they connect with each other and stick to the vascular wall (the ability to aggregate and adhere), while releasing biologically active substances that contribute to the restoration of the vascular wall when damaged (angiotrophic function). Platelets provide stop bleeding in small vessels (platelet-vascular hemostasis).

Determining the number of platelets is used to assess the risk of developing thrombotic and hemorrhagic complications, in hemorrhagic syndrome, in a comprehensive examination of the blood coagulation system, and for monitoring during chemotherapy. Fluctuations in the level of platelets during the day are possible.

Leukocytes (WBC, White Blood Cell) are immunity cells, their ratio and maturity is determined in the leukocyte formula.

In the normal leukocyte formula, you can see the following populations of cells and their percentage: neutrophils, monocytes, lymphocytes, basophils, eosinophils. Normally, these cells are present in the blood in relatively stable amounts. Their ratio depends on age. In children under 5-6 years of age, lymphocytes predominate in the blood formula, in adults there is a clear predominance of neutrophils.

What do the test results mean?

White blood cells: an increased number of white blood cells (leukocytosis) can be a sign of infection (both bacterial and viral, a marker of current inflammation (including autoimmune or allergic), a sign of a hematological disease.

A decrease in the level of leukocytes (leukopenia) may be associated with a severe infection (up to sepsis), with the toxic effect of medications taken, and with bone marrow damage.

Neutrophils: An increase in the number of neutrophils may be due to bacterial infection, inflammation, trauma, severe stress or early postoperative period.

A decrease in the number of neutrophils is usually associated with a reaction to drugs, autoimmune diseases, immunodeficiency states, and bone marrow damage.

Lymphocytes: an increase in the number of lymphocytes (lymphocytosis) can be observed in acute viral infections, infections of the herpes group (EBV infection, CMV infection, etc.), in some bacterial infections (whooping cough, tuberculosis intoxication), chronic inflammatory diseases ( such as ulcerative colitis), lymphocytic leukemia.

A decrease in the number of lymphocytes (lymphopenia) is often associated with autoimmune diseases, chronic viral infections (HIV, viral hepatitis), effects on the bone marrow, and taking corticosteroids.

Monocytes: Monocytes may be elevated in long-term chronic infections (tuberculosis, fungal infections), connective tissue diseases and vasculitis, monocytic or myelomonocytic leukemia.

A short-term decrease in the number of monocytes has no diagnostic value. A long-term decrease in the number of monocytes, combined with other pathology in the blood test, may be associated with aplastic anemia or bone marrow damage.

Eosinophils: An increase in the number of eosinophils may be associated with parasitic infestations, asthma, allergies, inflammatory diseases of the gastrointestinal tract.

The absence of eosinophils in the blood formula may be normal and has no clinical significance.

Basophils: an increase in the number of basophils can be observed in rare allergic reactions, chronic inflammatory diseases, kidney failure (uremia).

The decrease or absence of basophils has no clinical significance.

Platelets: in addition to true thrombocytopenia (low platelet count), the rare occurrence of EDTA-dependent thrombocytopenia may occur. Currently, to perform a general blood test, blood is taken in test tubes with an anticoagulant – EDTA.