Anemia of prematurity overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asra Firdous, M.B.B.S.[2]
Overview
Anemia of prematurity is a normochromic, normocytic anemia commonly seen in premature infants cared for in theneonatal intensive care unit.
Pathophysiology
Anemia of prematurity is multifactorial in origin. Phlebotomy is the major contributing factor. Other important factors are decreased erythropoietin production, increased erythropoietin metabolism, deficient iron stores, and decreased RBC lifespan.
Causes
Anemia of prematurity may be caused by a combination of blood loss, decreased RBC production, and shortened lifespan of RBC.
Epidemiology and Demographics
Anemia of prematurity is a common problem in NICU. It usually affects preterm and low birth weight infants born before 32-weeks of gestation. It affects male and female infants equally with no racial predilection.
Risk factors
Common risk factors in the development of anemia of prematurity are preterm birth, low birth weight, and excess blood loss during phlebotomy.
Natural History, Complications, and Prognosis
Common complications of anemia of prematurity include poor growth, apnea, and cardiovascular instability. The prognosis of anemia of prematurity is good with treatment
Diagnosis
History and Symptoms
Majority of patients with anemia of prematurity are either asymptomatic or develop vague and non-specific symptoms. They usually present with pallor and lethargy. Decreased activity, breathing difficulties, feeding difficulties, and difficulty in gaining weight are common symptoms. Less common symptoms are tachycardia, heart murmurs, and metabolic acidosis.
Physical Examination
Patients with anemia of prematurity usually appear pale and lethargic. Physical examination of patients with anemia of prematurity is usually remarkable for pallor, decreased activity, and [[poor growth].
Laboratory Findings
Laboratory findings consistent with the diagnosis of anemia of prematuriy reduced hemoglobin, hematocrit, and reticulocyte count in the blood.
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
PRBC transfusion is the mainstay in the treatment of anemia of prematurity. Treatment of infants with anemia of prematurity depends on the severity of symptoms. Blood transfusion and recombinant erythropoietin therapy are used to treat symptomatic infants.
Primary Prevention
Effective measures for the primary prevention of anemia of prematurity include limiting blood loss during phlebotomy, cord blood sampling for the laboratory investigations, and improving placental transfusion.