Case 3: Hydrops Fetalis, Pancytopenia, and Hemolytic Jaundice in a Preterm Neonate: A Diagnosis Made After 3 Months.

Abstract

A 33-week-gestation female neonate with a birthweight of 1,920 g is born via vaginal delivery to a primigravida woman who is blood group A positive. She is referred to the NICU 1 hour after birth as a case of antenatally diagnosed hydrops fetalis. ### Admission to 44 Hours After Birth The newborn has stable vital signs with no respiratory distress or circulatory insufficiency. She is pale, with a distended abdomen, and tense on palpation. Ultrasonography reveals significant ascites with no pleural or pericardial effusion. A complete blood cell (CBC) count reveals anemia with a hematocrit of 30%. The total leukocyte count, absolute neutrophil count, and platelet count are within normal reference ranges for gestational age. Direct Coombs test (DCT) result is negative. A provisional diagnosis of hydrops fetalis with anemia is rendered, and congenital parvovirus infection is considered as a strong possibility. ### 44 to 96 Hours After Birth The neonate develops indirect hyperbilirubinemia with a total serum bilirubin value of 15 mg/dL (256.5 μmol/L) with a further drop in hematocrit to 26%. The CBC count reveals new-onset thrombocytopenia, with a platelet count of 50×103/μL (50×109/L), leukopenia with a total leukocyte count of 3,600/μL (3.6×109/L), and neutropenia with an absolute neutrophil count of 800/μL (0.80×109/L). The peripheral smear shows red blood cells (RBCs) with 12% reticulocytes, fragmented cells, spherocytes, target cells, and anisopoikilocytosis. Both white blood cells and platelets are also reduced in the peripheral smear. Results of both the DCT and the indirect Coombs test are negative. The neonate is treated with phototherapy, …