Anemia of prematurity

Iron has an important role in various metabolic processes and as a central structure of hemoglobin (Hb) for the process of transporting oxygen. Malnutrition from the beginning of pregnancy until the end of pregnancy will cause problems with labor, premature birth, low birth weight in infants to maternal death. The importance of examining serum Ferritin levels as early detection of iron deficiency anemia is especially carried out before pregnancy or early pregnancy (trimester I), given the high incidence of iron deficiency anemia in pregnant women and its impacts.

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The benefit to risk ratio of the treatment with erythropoietin (EPO) as a means of limiting the number of transfusions in very preterm infants during hospitalization, seems to be modest since the adoption of restrictive transfusion criteria and of policy limiting phlebotomy losses.

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Preterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions.

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Necrotizing enterocolitis (NEC) is a leading cause of neonatal morbidity and mortality in premature infants. To date, no effective biomarkers exist to predict which premature infants will develop NEC, limiting targeted prevention strategies.

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Classes There are five major classes of hemoglobinopathies (Table 99-1). Structural hemoglobinopathies occur when mutations alter the amino acid sequence of a globin chain, altering the physiologic properties of the variant hemoglobins and producing the characteristic clinical abnormalities. The most clinically relevant variant hemoglobins polymerize abnormally, as in sickle cell anemia, or exhibit altered solubility or oxygen-binding affinity. Thalassemia syndromes arise from mutations that impair production or translation of globin mRNA, leading to deficient globin chain biosynthesis.

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Calculation of Reticulocyte Production Index Correction #1 for anemia: This correction produces the corrected reticulocyte count In a person whose reticulocyte count is 9%, hemoglobin 7.5 g/dL, hematocrit 23%, the absolute reticulocyte count = 9 x (7.5/15) [or x (23/45)]= 4.5% Correction #2 for longer life of prematurely released reticulocytes in the blood: This correction produces the reticulocyte production index In a person whose reticulocyte count is 9%, hemoglobin 7.5 gm/dL, hematocrit 23%, the reticulocyte production index Figure 58-13 Correction of the reticulocyte count.

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