![]() Rh incompatibility occurs in 10.6 per 10,000 live births 50 percent of these infants develop anemia Positive Coombs test elevated bilirubin level normocytic anemia with elevated reticulocyte count Jaundice and mild anemia infants with severe isoimmunization (e.g., untreated Rh incompatibility) may present with hydrops fetalis Tachypnea, pallor, and mental status change (irritability, poor feeding) > 20 percent loss of blood volume results in shock and cardiopulmonary collapseĪnemia with normal indices reticulocyte count is initially normal, then increases positive Kleihauer-Betke test in maternal-fetal hemorrhageĪccounts for 5 to 10 percent of all cases of severe neonatal anemia Hemorrhage (placental abruption, subgaleal, traumatic) maternal-fetal and twin-twin transfusion A peripheral smear can provide additional information in patients with anemia of any morphology. Common tests used in the evaluation of macrocytic anemias include vitamin B 12 and folate levels, and thyroid function testing. A low reticulocyte count suggests aplasia or a bone marrow disorder. If the reticulocyte count is elevated, the patient should be evaluated for blood loss or hemolysis. Workup of normocytic anemia is based on bone marrow function as determined by the reticulocyte count. Normocytic anemia may be caused by chronic disease, hemolysis, or bone marrow disorders. Other tests used in the evaluation of microcytic anemia include serum iron studies, lead levels, and hemoglobin electrophoresis. If the anemia is severe or is unresponsive to iron therapy, the patient should be evaluated for gastrointestinal blood loss. Mild microcytic anemia may be treated presumptively with oral iron therapy in children six to 36 months of age who have risk factors for iron deficiency anemia. ![]() Anemia is classified as microcytic, normocytic, or macrocytic, based on the mean corpuscular volume. Screening is recommended only for high-risk children. Most children with anemia are asymptomatic, and the condition is detected on screening laboratory evaluation. Anemia is defined as a hemoglobin level of less than the 5th percentile for age. ![]()
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