【儿科】_新生儿红细胞增多症儿科接诊注意事项.pptVIP

新生儿红细胞增多症/接诊注意事项 Neonatal polycythemia Affects approximately 1 to 5 percent of newborns Many affected infants are asymptomatic Characteristic clinical features result from hyperviscosity and/or the metabolic effects of an increased red blood cell mass Neonatal polycythemia The mean hematocrit (hct) and hemoglobin concentrations from capillary samples in healthy term infants at birth are 61±7 percent and 19.3±2.2 g/dL Definition Polycythemia Term infant is considered to be polycythemic if the hct from a peripheral venous sample is 65 percent or the hemoglobin is 22 g/dL Hcts of blood from venous samples may be as much as 15 percent lower than those obtained from capillary samples Definition Hyperviscosity：blood viscosity 12 centipoise, measured at a shear rate of 11.5 per second; or 6 centipoise, measured at a shear rate of 106 per second Blood viscosity and hct have a linear relationship when the hct is 60 percent.This relationship becomes exponential when the hct exceeds 65 percent, such that a small increase in hct is associated with a dramatic increase in viscosity. Hyperviscosity occurred in only 47.4 percent of infants with polycythemia Influenceing factors Time delay between birth and clamping of the umbilical cord Site of blood sampling -Hct values are highest in capillary samples, intermediate in peripheral venous samples, and lowest in samples drawn from the umbilical vein Age at the time of sampling – Hcts increase from birth, reaching a maximum at approximately two hours of age, then decrease to levels in cord blood by 18 hours of age Method of hct measurement – Values obtained from centrifuged samples are higher than those using cell counters and correlate better with blood viscosity CAUSES The causes of polycythemia are multifactorial but are due to two major mechanisms: passive (erythrocyte transfusion) active (increased intrauterine erythropoiesis) Erythrocyte transfusion（passive） Delayed clamping of the umbilical cord (eg, 2 minutes af