Advertisement

Neonatology pp 1125-1139 | Cite as

Polycythemia and Hyperviscosity in Neonates

  • Otwin Linderkamp
Reference work entry

Abstract

Polycythemia and the resulting increase in blood viscosity are common in the neonatal period. However, neonatal blood has several favorable properties including lower plasma viscosity, RBC aggregation, and increased red blood cell deformability compared with adults. Oxygen transport to vital organs is, therefore, usually not compromised when the hematocrit (HCL) is below 0.70 L/L. Polycythemia may develop before (increased erythropoiesis, prenatal transfusion syndromes) or after birth (late cord-clamping). Nevertheless, delayed or late cord-clamping should be encouraged because of favorable circulatory effects – among other advantages. Signs of polycythemia often result from the underlying disorder (e.g., intrauterine asphyxia, maternal diabetes) rather than from the increased HCT and blood viscosity. Postnatal blood volume loss contributes to the development of polycythemia in most affected infants. Early oral feeding or, if necessary, additional i.v. fluid is therefore the first-line treatment and prophylaxis against polycythemia. Because partial exchange transfusion (PET) did not improve the long-term neurodevelopmental outcome and even increased the risk of early complications (necrotizing enterocolitis, septicemia) in polycythemic infants, indications for PET should be restricted to symptomatic neonates with HCT ≥0.70 L/L and to asymptomatic infants with HCT ≥0.75 L/L.

Abbreviations

HCT

Hematocrit

NEC

Necrotizing enterocolitis

PET

Partial exchange transfusion

RBC

Red blood cell

References

  1. Abiramalatha T, Kumar M, Shabeer MP, Thomas N (2016) Advantages of being diligent: lessons learnt from umbilical venous cauterization in neonates. BMJ Case RepGoogle Scholar
  2. Alsafadi TRM, Hashmi SM, Youssef HA, Suliman AK (2014) Polycythemia in neonatal intensive care unit, risk factors, symptoms, pattern, and management controversy. J Clin Neonatol 3:93–98CrossRefGoogle Scholar
  3. Aperia A, Bergqvist G, Bomberger O et al (1974) Renal function in newborn infants with high hematocrit values before and after isovolemic hemodilution. Acta Paediatr 63:878–884CrossRefGoogle Scholar
  4. Bada HS, Korones SB, Kolni HW et al (1986) Partial plasma exchange transfusion improves cerebral hemodynamics in symptomatic neonatal polycythemia. Am J Med Sci 291:157–163CrossRefGoogle Scholar
  5. Bada HS, Korones SB, Pourcyrous M et al (1992) Asymptomatic syndrome of polycythemic hyperviscosity: effect of partial plasma exchange transfusion. J Pediatr 120:579–85CrossRefGoogle Scholar
  6. Black VD, Lubchenco LO, Koops BL et al (1985a) Neonatal hyperviscosity: randomized study of effect of partial plasma exchange transfusion on long-term outcome. Pediatrics 75:1048–1053PubMedGoogle Scholar
  7. Black VD, Rumack CM, Lubchenko LO, Koops BL (1985b) Gastrointestinal injury in polycythemic term infants. Pediatrics 76:225–231PubMedGoogle Scholar
  8. Brans YW, Shannon DL, Ramamurthy RS (1981) Neonatal polycythemia. II. Plasma, blood, and red cell volume estimates in relation to hematocrit levels and quantity of intrauterine growth. Pediatrics 68:175–181PubMedGoogle Scholar
  9. Buonocore G, Bernie S, Gioia D et al (1991) Whole blood filterability in the neonate. Clin Hemorheol 11:41–48Google Scholar
  10. Capasso L, Raimondi F, Capasso A et al (2003) Early cord clamping protects at-risk neonates from polycythemia. Biol Neonate 83:197–200CrossRefGoogle Scholar
  11. Christensen RD, Baer VL, Gerday E et al (2014) Whole blood viscosity in the neonate: effects of gestational age, hematocrit, mean corpuscular volume and umbilical cord milking. J Perinatol 34:16–21CrossRefGoogle Scholar
  12. De Waal KA, Baerts W, Offringa M (2006) Systematic review of the optimal fluid for dilutional exchange transfusionin in neonatal poycythaemia. Arch Dis Child Fetal Neonatal Ed 91:F7–F10CrossRefGoogle Scholar
  13. Delaney-Black V, Camp BW, Lubchenco LO et al (1989) Neonatal hyperviscosity association with lower achievement and IQ scores at school age. Pediatrics 83:662–667PubMedGoogle Scholar
  14. Dempsey EM, Barrington K (2006) Short and long term outcomes following partial exchange transfusion in the polycythaemic newborn: a systematic review. Arch Dis Child Fetal Neonatal Ed 91:F2–F6CrossRefGoogle Scholar
  15. Dollberg S, Marom R, Mimouni FB, Littner Y (2007) Increased energy expenditure after dilutional exchange transfusion for neonatal polycythemia. J Am Coll Nutr 26:412–415CrossRefGoogle Scholar
  16. Drew JH, Guaran RL, Cichello M, Hobbs JB (1997) Neonatal whole blood hyperviscosity: the important factor influencing later neurologic function is the viscosity and not the polycythemia. Clin Hemorheol Microcirc 17:67–72PubMedGoogle Scholar
  17. Ergenecon E, Hirfanoglu IM, Turan O et al (2011) Partial exchange transfusion results in increased cerebral oxygenation and faster peripheral microcirculation in newborns with polycythemia. Acta Paediatr 100:1432–1436CrossRefGoogle Scholar
  18. Erickson-Owens DA, Mercer JS, Oh W (2012) Umbilical cord-milking in term infants delivered by cesarean section: a randomized controlled trial. J Perinatol 32:580–584CrossRefGoogle Scholar
  19. Goldberg K, Wirth FH, Hathaway WE et al (1982) Neonatal hyperviscosity II. Effect of partial plasma exchange transfusion. Pediatrics 69:419–425PubMedGoogle Scholar
  20. Goldstein M, Stonestreet B, Brann BS, Oh W (1988) Cerebral cortical blood flow and oxygen metabolism in normocythemic hyperviscous newborn piglets. Pediatr Res 24:486–489CrossRefGoogle Scholar
  21. Holzman IR, Tabata B, Edelstone DI (1986) Blood flow and oxygen delivery to the organs of the neonatal lamb as a function of hematocrit. Pediatr Res 20:1274–1279CrossRefGoogle Scholar
  22. Host A, Ulrich M (1982) Late prognosis in untreated neonatal polycythemia with minor or no symptoms. Acta Paediatr Scand 71:629–633CrossRefGoogle Scholar
  23. Hutton EK, Hassan ES (2007) Late vs early clamping of the umbilical cord in full-term neonates. Systematic review and meta-analysis of controlled trials. JAMA 297:1241–1252CrossRefGoogle Scholar
  24. Jobling J, Henry E, Wiedmeier SE, Christensen RD (2009) Reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period: data from a multihospital health care system. Pediatrics 123:e333–e337Google Scholar
  25. Katheria AC, Lakshminrusimha S, Rabe H et al (2016) Placental transfusion: a review. J Perinatol (Epub ahead of print)Google Scholar
  26. Kotagal UR, Keenan WJ, Reuter JH et al (1977) Regional blood flow in polycythemia and hypervolemia. Pediatr Res 11:394ACrossRefGoogle Scholar
  27. Kumar A, Ramji S (2004) Effect of partial exchange transfusion in asymptomatic polycythemic LBW infants. Indian Pediatr 41:366–372PubMedGoogle Scholar
  28. Liem KD, Hopman JC, Oeseburg B et al (1997) The effect of blood transfusion and haemodilution on cerebral oxygenation and in newborn infants investigated by near infrared spectrophotometry. Eur J Pediatr 156:305–310CrossRefGoogle Scholar
  29. Linderkamp O (1982) Placental transfusion: determinants and effects. Clin Perinatol 9:559–592CrossRefGoogle Scholar
  30. Linderkamp O (1996) Pathological flow properties of blood in the fetus and neonate. Clin Hemorheol 16:105–116Google Scholar
  31. Linderkamp O (2004) Blood viscosity of the neonate. NeoReviews 5:e406–e416CrossRefGoogle Scholar
  32. Linderkamp O (2007) Hemorheology of the fetus and neonate. In: Baskurt OK, Hardeman MR, Rampling MW, Meiselman HJ (eds) Handbook of hemorheology and hemodynamics, vol 69, Biomedical and health research. IOS Press, AmsterdamGoogle Scholar
  33. Linderkamp O, Versmold HT, Strohhacker I et al (1977) Capillary-venous hematocrit differences in newborn infants. I. Relationship to blood volume, peripheral blood flow, and acid–base parameters. Eur J Pediatr 127:9–14CrossRefGoogle Scholar
  34. Linderkamp O, Versmold HT, Riegel KP, Betke K (1984) Contributions of red cells and plasma to blood viscosity in preterm and full-term infants and adults. Pediatrics 74:45–51PubMedGoogle Scholar
  35. Linderkamp O, Nash GB, Wu PYK, Meiselman HJ (1986) Deformability and intrinsic material properties of neonatal red blood cells. Blood 67:1244–1250PubMedGoogle Scholar
  36. Linderkamp O, Stadler AA, Zilow EP (1992a) Blood viscosity and optimal hematocrit in preterm and full-term neonates in 50- to 500-μm tubes. Pediatr Res 32:97–102CrossRefGoogle Scholar
  37. Linderkamp O, Nelle M, Kraus M, Zilow EP (1992b) The effect of early and late cord-clamping on blood viscosity and other hemorheological parameters in full-term neonates. Acta Paediatr 81:745–750CrossRefGoogle Scholar
  38. Linderkamp O, Bauer J, Noecker-Ribaupierre M, Riegel KP (2004) Neonatal polycythemia resulting from late cord-clamping does not cause developmental or neurologic sequelae. Pediatr Res 56:490Google Scholar
  39. Linderrkamp O, Kiau U, Ruef P (1997) Cellular and membrane deformability of red blood cells in preterm infants with and without growth retardation. Clin Hemorheol Microcirc 17:279–283Google Scholar
  40. Maertzdorf WJ, Aldenhuyzen-Dorland W, Slaaf DW et al (1991) Circulating blood volume in appropriate and small for gestational age full term and preterm polycythaemic infants. Acta Paediatr Scand 80:620–627CrossRefGoogle Scholar
  41. Maertzdorf WJ, Tangelder GJ, Slaaf DW, Blanco CE (1993) Effects of partial plasma exchange transfusion on blood flow velocity in large arteries of arm and leg, and in cerebral arteries in polycythaemic newborn infants. Acta Paediatr 82:12–18CrossRefGoogle Scholar
  42. Maerztdorf WJ, Tangelder GJ, Slaaf DW, Blanco CE (1989) Effects of partial plasma exchange transfusion on cerebral blood flow velocity in polycythaemic preterm, term and small for date newborn infants. Eur J Pediatr 148:774–778CrossRefGoogle Scholar
  43. Mandelbaum VH, Guajardo CD, Nelle M, Linderkamp O (1994) Effects of polycythaemia and haemodilution on circulation of neonates. Arch Dis Child Fetal Neonatal Ed 71:F53–F54CrossRefGoogle Scholar
  44. Merlob P, Litmanovitch I, Mor N et al (1990) Necrotizing enterocolitis after intravenous immunoglobulin treatment for neonatal isoimmune thrombocytopenia. Eur J Pediatr 149:432–433CrossRefGoogle Scholar
  45. Mimouni F, Miodovnik M, Siddiqi TA et al (1986) Neonatal polycythemia in infants of insulin-dependent diabetic mothers. Obstet Gynecol 68:370–372CrossRefGoogle Scholar
  46. Mimouni FB, Merlob P, Dollberg S, Mandel D (2011) Neonatal polycythemia: critical review and a consensus statement of the Israeli Neonatology Association. Acta Paediatr 100:1290–1296CrossRefGoogle Scholar
  47. Morag I, Strauss T, Lubin D et al (2011) Restrictive management of neonatal polycythemia. Am J Perinatol 28:677–682CrossRefGoogle Scholar
  48. Nelle M, Zilow EP, Kraus M et al (1993) The effect of Leboyer delivery on blood viscosity and other hemorheological parameters in term neonates. Am J Obstet Gynecol 169:189–193CrossRefGoogle Scholar
  49. Oh W, Blankenship W, Lind J (1966) Further study of neonatal blood volume in relation to placental transfusion. Ann Paediatr 207:147–159Google Scholar
  50. Özek E, Soll R, Schimmel MS (2010) Partial exchange transfusion to prevent neurodeveplopmental disability in infants with polycythemia. Cochrane Database Syst Rev 2010:CD005089Google Scholar
  51. Pappas A, Delaney-Black V (2004) Differential diagnosis and management of polycythemia. Pediatr Clin North Am 51:1063–1086CrossRefGoogle Scholar
  52. Philip AGS, Saigal S (2004) When should we clamp the umbilical cord? NeoReviews 5:e142–e154CrossRefGoogle Scholar
  53. Ratrisawada V, Plubrukarn R, Trachulchang K et al (1994) Developmental outcome of infants with neonatal polycythemia. J Med Assoc Thai 77:76–80Google Scholar
  54. Rivers RPA (1975) Coagulation changes associated with high hematocrit in the newborn infant. Acta Pediatr 64:449–456CrossRefGoogle Scholar
  55. Rosenkrantz TS (2003) Polycythemia and hyperviscosity in the newborn. Semin Thromb Hemost 29:515–527CrossRefGoogle Scholar
  56. Rosenkrantz TS, Oh W (1982) Cerebral blood flow velocity in infants with polycythemia and hyperviscosity: effects of partial exchange transfusion with Plasmanate. J Pediatr 101:9498CrossRefGoogle Scholar
  57. Sankar MJ, Agarwal R, Deorari A, Paul VK (2010) Management of polycythemia in neonates. Indian J Pediatr 77:1117–1121CrossRefGoogle Scholar
  58. Scarcella A, Gambardella P (1986) Partial exchange transfusion using peripheral vessels in polycythaemic newborn infants. Eur J Pediatr 144:545–546CrossRefGoogle Scholar
  59. Schimmel MS, Bromiker R, Soll RF (2004) Neonatal polycythemia: is partial exchange transfusion justified? Clin Perinatol 31:545–553CrossRefGoogle Scholar
  60. Shohat M, Merlob P, Reisner SH (1984) Neonatal polycythemia: I. Early diagnosis and evidence relating to time of sampling. Pediatrics 73:7–10PubMedGoogle Scholar
  61. Supapannachart S, Siripoonya P, Boonwattanasoontorn W, Kanjanavanit S (1999) Neonatal polycythemia: effects of partial exchange transfusion using fresh frozen plasma, Haemaccel and normal saline. J Med Assoc Thai 82(Suppl 1):S82–S86PubMedGoogle Scholar
  62. Swetnam SM, Yabek SM, Alverson DC (1987) Hemodynamic consequences of neonatal polycythemia. J Pediatr 110:443–447CrossRefGoogle Scholar
  63. Uslu S, Ozdemir H, Bulbul A et al (2011) The evaluation of polycythemic newborns: efficacy of partial exchange transfusion. J Matern Fetal Neonatal Med 24:1492–1497CrossRefGoogle Scholar
  64. Van der Elst CW, Molteno CD, Malan AF, Heese H (1980) The management of polycythaemia in the newborn infant. Early Hum Dev 4:393–403CrossRefGoogle Scholar
  65. Villalta IA, Pramanik AK, Diaz-Blanco J, Herbst JJ (1989) Diagnostic errors in neonatal polycythemia based on method of hematocrit determination. J Pediatr 115:460–462CrossRefGoogle Scholar
  66. Vlug RD, Lopriore E, Janssen M et al (2015) Thrombocytopenia in neonates with polycythemia: incidence, risk factors and clinical outcome. Expert Rev Hematol 8:99–102CrossRefGoogle Scholar
  67. Werner EJ (1995) Neonatal polycythemia and hyperviscosity. Clin Perinatol 22:693–710CrossRefGoogle Scholar
  68. Wiswell TE, Cornish JD, Northam RS (1986) Neonatal polycythemia: frequency of clinical manifestations and other associated findings. Pediatrics 78:26–30PubMedGoogle Scholar
  69. Yao AC, Lind J (1982) Placental transfusion. A clinical and physiological study. Thomas Publisher, SpringfieldGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of NeonatologyDepartment of Pediatrics, University of HeidelbergHeidelbergGermany

Personalised recommendations