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
Common causes of anemia of prematurity include preterm birth, blood loss during phlebotomy, increased destruction of red blood cells, and decreased production of red blood cells. Iron, vitamin B6, vitamin E, and folate deficiencies are less common causes of anemia of prematurity.
Epidemiology and Demographics
Anemia of prematurity is a common problem in neonatal intensive care unit (NICU). It usually affects preterm and low birth weight infants born before 32-weeks of gestation. The risk of anemia of prematurity is inversely proportional to birth weight and gestational age at time of birth. It affects male and female infants equally with no racial predilection.
Risk factors
Anemia of prematurity is a serious problem in preterm infants. Common risk factors in the development of anemia of prematurity are preterm birth, low birth weight, and excess blood loss during phlebotomy. Less common risk factors are family history of anemia, anemia and nutritional deficiencies in mother during pregnancy, multiple gestations, complications during pregnancy and delivery, blood loss during pregnancy and delivery, and twin-to-twin transfusion.
Natural History, Complications, and Prognosis
Anemia of prematurity can be asymptomatic or produce abnormal clinical signs and symptoms depending on the hemoglobin levels. Mild symptoms usually resolve spontaneously without treatment. Severe symptoms require treatment with blood transfusion and erythropoietin. Untreated anemia of prematurity can lead to poor growth, apnea, and cardiovascular instability. The prognosis of anemia of prematurity is good with prompt diagnosis and early 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 are reduced hemoglobin, hematocrit, and reticulocyte count in the blood. Normocytic, normochromic RBCs and red blood cell precursors are seen predominantly on the peripheral smear of patients with anemia of prematurity.
Ultrasound
There are no ultrasound findings associated with anemia of prematurity. Cranial USG and abdominal USG can be done to exclude other causes of anemia.
Other Imaging Findings
There are no other imaging findings associated with anemia of prematurity.
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.