Haematological abnormalities in the growth-restricted infant

Abstract

The sequelae of intra-uterine growth restriction (IUGR) and placental insufficiency are frequently encountered in the neonatal intensive care unit, particularly in the preterm baby. These babies have a number of distinctive haematological abnormalities that include the triad of (i) neutropenia, (ii) thrombocytopenia, and (iii) increased red cell production (large numbers of nucleated red cells and/or polycythaemia), together with signs of hyposplenism (red cell targets, spherocytes and Howell-Jolly bodies). These changes are present at birth and therefore can be assumed to begin in fetal life. The haematological abnormalities involve all blood cell lineages and affect mature cells and progenitors, suggesting that a common factor(s) causes fundamental alterations in the process of haemopoiesis in the fetus. This review discusses the pathogenesis, clinical consequences and management of these abnormalities in the newborn infant with IUGR.