Incidence Of Polycythemia Research Articles

An epidemiologic blood group-1

Aim Polycythemia, also known as erythrocytosis, is an abnormal accumulation of red blood cells, packed cell volume, and hemoglobin that can lead to debilitating symptoms and significant mortality. Polycythemia is estimated to affect 22 people per 100,000. The epidemiology of polycythemia in Iraq is limited. This study aimed to investigate the prevalence and incidence of polycythemia in Babylon City, Iraq, from 2018 to 2022 and to identify populations at high risk. Materials and Methods Due to the relative scarcity of epidemiological studies on polycythemia in Iraq, this study was conducted to identify some epidemiological features of polycythemia patients in Babylon province. A study conducted at the Babylon Central Blood Bank included 220 polycythemia patients. This data was obtained by reviewing all patient documents and the registration book from 2018 to 2022. Participants completed a questionnaire with information about their Sex, age, place of residence, smoking habits, and blood group. Statistics were analyzed using SPSS version 23.0 and Prism software. Results were presented in numbers and percentages and analyzed using the Chi-square test. Results Results indicated that polycythemia increased between 2018 and 2020, with the highest numbers in 2018 and decreasing in 2022. There was a higher frequency in the age group of (41-50) years, and it was more common in males with polycythemia (92.72%) who were smokers (79.09%). Most polycythemia patients had the B blood group (38.2%), while the AB blood group had the lowest percentage (5.5%), and most cases were Rh-positive (91.8%). Conclusion this study provided an overview of the epidemiology of polycythemia in Babylon, Iraq. The findings indicate that polycythemia was more prevalent in men of middle age and with blood group B+. Therefore, further research is needed to examine the relevance of the ABO blood group to polycythemia severity and susceptibility. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1068-1074

Correlation of cerebral blood flow velocity with haematocrit in neonates at risk of polycythaemia: a COHORT study

Background: The incidence of polycythemia is 1.5-4% of all live births. To diagnose polycythemia, a venous hematocrit is necessary, and polycythaemia is linked to changes in cerebral blood flow. The primary objective is to compare cerebral blood flow velocity (CBFV) and resistance index (RI) between polycythemia and normocythemia groups. The secondary objective is to correlate the peak systolic velocity (PSV) of anterior and middle cerebral arteries (ACA and MCA) with hematocrit in neonates at risk for polycythemia. Methods: In a prospective observational study, babies with a gestational age of >35 weeks and a risk factor for polycythaemia were enrolled in the study. Free-flowing venous blood was sent for haematocrit measurement between 2 and 6 hours of life. Repeat PCV is sent to babies with a prior value of PCV >65% at 36 hours of life or before discharge. PSV, end diastolic velocity (EDV), RI of ACA and MCA were measured using Mindray portable ultrasound machine with a mini- curved ultrasound transducer (8-13 mhz). Data is entered in excel and analysed. Results: Out of 75 enrolled babies, 19 had polycythaemia. The mean PSV±SD of MCA was 27.84±6.04 cm/s and 27.27±5.74 cm/s in the normocythemia and polycythemia groups, respectively, at 6 hours of life, which is statistically insignificant. The mean PSV±SD of MCA was 31.41±6.92 cm/s and 29.61±6.57 cm/s in normocythemia and polycythaemia groups, respectively, at 36 hours of life, which is statistically insignificant too. Conclusions: Cerebral Doppler values did not correlate with haematocrit between the normocythemia and polycythemia groups in the neonates at risk of polycythemia.

Comparing the safety and effectiveness of various umbilical cord milking techniques and delayed cord clamping in full-term and preterm infants: A systematic review and meta-analysis.

We compare the hematocrit, hemoglobin, need for transfusion, recurrent phototherapy, serum bilirubin level, and serum ferritin at different time frames for the umbilical cord milking (UCM) and delayed cord clamping (DCC) in both full-term and preterm infants. A comprehensive search through various databases aimed to compare UCM and DCC studies until May 2nd, 2023. Cochrane and NIH tools assessed RCTs and cohorts, respectively. Meta-analysis employed Review Manager 5.4 software, calculating MD and RR with 95% CIs for continuous and dichotomous data. We included 20 studies with a total of 5189 infants. Regarding preterm infants, hematocrit level showed no significant difference between intact Umbilical Cord Milking (iUCM) compared to DCC (MD = -0.24, 95% CI [-1.11, 0.64]). Moreover, Neonatal death incidence was significantly higher with the UCM technique in comparison to DCC (RR = 1.28, 95% CI [1.01 to 1.62]). Regarding term and late preterm infants, Hematocrit level showed no significant difference between the iUCM or cUCM techniques compared to DCC (MD = 0.21, 95% CI [-1.28 to 1.69]), (MD = 0.96, 95% CI [-1.02 to 2.95]), respectively. UCM led to a higher risk of neonatal death in preterm infants compared to DCC. However, the incidence of polycythemia was lower in the UCM group. Additionally, UCM was associated with higher rates of severe IVH events. Based on these findings, DCC may be preferred due to its lower incidence of severe IVH and neonatal death.

Effects of umbilical cord milking versus delayed cord clamping on systemic blood flow in intrauterine growth-restricted neonates: A randomized controlled trial.

UCM significantly increases SVC flow, venous hematocrit, and CrSO2 compared to DCC in IUGR neonates without any difference in other hemodynamic parameters and incidences of polycythemia and jaundice requiring phototherapy; however, the need for non-invasive respiratory support was higher with UCM. Clinical trial registry of India (CTRI/2021/03/031864). •Umbilical cord milking (UCM) increases superior vena cava blood flow (SVC flow) and hematocrit without increasing the risk of symptomatic polycythemia and jaundice requiring phototherapy in preterm neonates compared to delayed cord clamping (DCC). •An association between UCM and intraventricular hemorrhage in preterm neonates < 28weeks of gestation is still being investigated. •Placental transfusion by UCM compared to DCC increases SVC flow, regional cerebral oxygenation, and hematocrit without increasing the incidence of symptomatic polycythemia and jaundice requiring phototherapy in intrauterine growth-restricted neonates. •UCM also increases the need for non-invasive respiratory support compared to DCC.

CLINICAL PROFILE OF POLYCYTHEMIA IN SMALL FOR GESTATIONAL AGE NEONATES ADMITTED TO THE NEONATAL INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

Background:-Polycythemia is the principal cause of hyperviscosity of blood in neonates and is associated with serious, sometimes life threatening complication of the brain, heart, kidney, lungs and intestines. The incidence is high in small for gestational age neonates. To assess the incidence, clinical prole of Aim:- polycythemia among Inborn small for gestational age newborns admitted in the Neonatal Intensive Care Unit of Jorhat Medical College and Hospital. Objectives:-To determine the incidence of polycythemia among small for gestational babies admitted in the Neonatal Intensive Care Unit of Jorhat Medical College &amp; Hospital, and to assess the pattern of clinical manifestations and complications attributable to polycythemia. Method:-130 consecutive small for gestational age inborn babies admitted into the NICU of Jorhat Medical College and Hospital, Jorhat during the period of 1 year from May 2021 to April 2022 were screened for polycythemia at 2 - 4 hours of postnatal age using venous hematocrit. The newborns were considered polycythemic if the venous hematocrit was ≥65%. The incidence of polycythemia in small for gestational age was 31.5% Results:- (41 out of 130 babies). Among the 130 small for gestational age babies, 57 were preterm,49 were term and 24 were post term. The incidence of polycythemia was 29.2%in preterm, 36.7 % in term and 24.3% in post term babies. Among the polycythemic babies, icterus(70.7%) was the commonest clinical manifestation followed by lethargy (60.9%) and tachypnoea (36.5%).Hyperbilirubinemia (70.7%) was the commonest laboratory abnormality followed by thrombocytopenia(63.4%), hypokalemia (17.07%) , hypernatraemia (9.7%), hypoglycaemia (7.3%) , hypocalcemia (7.3%), hyperkalemia (4.8%) and hyponatremia (2.4%).39 babies underwent partial exchange transfusion with normal saline for correction of polycythemia. There was improvement in clinical features and hematocrit levels following partial exchange transfusion. Two asymptomatic babies did not undergo partial exchange transfusion and were managed conservatively. Conclusion:-Polycythemia is a silent clinical condition which if unrecognized can result in signicant morbidity in neonates. As incidence is high in small for gestational age newborns, these babies must be actively screened for its timely detection and management in order to prevent complications attributable to polycythemia-hyperviscosity syndrome. Key words:- Neonatal polycythemia, small for gestational age, Hematocrit, Partial exchange transfusion

Neonatal polycythemia: incidence and associated factors

Background: The chief concern in neonatal polycythemia (NPC) is the development of complications due to hyper viscosity. We aimed to study risk factors, clinical features, laboratory investigations, management and outcome of neonates with polycythemia at our set up. Methods: A prospective study was conducted in the frame of January 2021 to January 2022 at tertiary care institute in Ahmedabad, all neonates with gestational age ≥34 weeks were evaluated and those with venous hematocrit more than 65% or hemoglobin exceeding 22 mg/dl were included in the study. The clinical features and laboratory parameters were noted. Asymptomatic neonates or neonates with mild polycythemia were observed for rising hematocrit or development of symptoms whereas symptomatic neonates or neonates with moderate and severe polycythemia were subjected to interventions as needed. Results: Incidence of polycythemia in this study was 11.18 per 100 neonates. The most common symptoms observed were jaundice in 68 (43.3%) neonates, followed by lethargy in 33 (21%). Other symptoms observed were refusal to feed (18.4%), respiratory distress (11.4%), jitteriness (6.3%), decrees urine output (2.5%), and cyanosis (1.2%). The noted laboratory abnormalities were hyperbilirubinemia (43.3%) followed by thrombocytopenia (40.1%), hypoglycemia (28%) and hypocalcemia (4.4%). The 35.6% neonates require hydration and 22.5% of neonates required partial exchange transfusion, rest were managed conservatively. Conclusions: the study suggested that polycythemia is a frequent problem among neonates. More than one third of them can be asymptomatic indicating the importance of assessing the associates’ risk factors.

A Study on Incidence, Pattern of Clinical Features, Laboratory Abnormalities and Outcome of Neonatal Polycythaemia in a Tertiary Care Hospital, Odisha, India

Introduction: Neonatal polycythaemia is a commonly encountered morbidity and mortality among neonates admitted to neonatal care units and sick newborn care units. Most affected infants have no clinical symptoms and signs, but neonates may present with lethargy, poor feeding, plethora, cyanosis and jaundice within 12-72 hrs. Aim: To find out the incidence and clinical manifestations of neonatal polycythaemia along with detection of disease by laboratory abnormalities. Materials and Methods: This was a hospital-based, prospective, observational study conducted in the Neonatal Care Unit of Sriram Chandra Bhanja Medical College, Eastern Odisha, India, in 1760 neonates, from October 2018 to September 2020. All neonates admitted through Outdoor and Emergency were included in this study irrespective of gestation, birth weight, maturity and mode of delivery with haematocrit &gt;65% at 12 hours of life. These polycythaemic babies were further categorised on the basis of maturity, gestational age, birth weight, gender and the clinical features, laboratory abnormalities were noted, Partial Exchange Transfusion (PET) when required was done through central route, the umbilical venous catheter was used for withdrawing blood while same amount of normal saline was replaced through a peripheral vein, and in asymptomatic cases additional fluid of 20 mL/kg was added to the daily fluid requirements either through enteral or parenteral route and outcomes were noted. Short-term outcome at 48 hours was measured by decreasing haematocrit with improvement of signs and symptoms. Chi-square test was employed to analyse the collected data using Statistical Package for the Social Sciences (SPSS) software version 20.0. The p-value &lt;0.05 was considered statistically significant. Results: Out of 1760 newborns enrolled, (n=75) were polycythaemic. The Incidence of polycythaemia was 4.26%), which was significantly higher among Small for Gestational Age (SGA) compared to Large for Gestational Age (LGA) neonates (p-value=0.0214). Clinical features in decreasing order were lethargy (66.6%), poor feeding (66.6%), Plethora (53.3%), cyanosis (40%) and jaundice (33.3%). Main laboratory abnormalities were hypoglycaemia (36%), hyperbilirubinaemia (28%), thrombocytopenia (22.66%) and hypocalcaemia (13.3%). Out of 75 polycythemic neonates, n=17 (22.67%) underwent PET and rest 58 (77.33%) neonates were treated with extra fluid of 20 mL/kg/day. Conclusion: Study showed that lethargy and poor feeding were the main presentation and hypoglycaemia as the major laboratory abnormality. The incidence of polycythaemia was high among SGA neonates and the response to partial exchange transfusion as well as extra fluid was good which was characterised by decreasing haematocrit values with improvement of signs and symptoms.

Neonatal Problems and Infancy Growth of Term SGA Infants: Does "SGA" Definition Need to Be Re-evaluated?

Introduction: The exact definition of small-for-gestational-age (SGA) infant is still controversial among clinicians. In this study, we aimed to understand which definition is better in terms of establishing both early postnatal problems and growth. In this way, we compared early neonatal problems and infancy growth of term infants with birth weight (BW) < -2 SDS and with BW between 10th percentile (−1.28 SDS) and −2 SDS.Methods: A single center retrospective cohort study was conducted. Preterm infants, multiple gestations and newborns with any congenital anomalies were excluded from the study. Study group was defined as Group 1 (n = 37), infants BW < −2.00 SDS; Group 2 (n = 129), between −1.28 and −2.00 SDS; and Group 3 (n = 137), randomly selected newborns with optimal-for-gestational-age (BW between −0.67 and +0.67 SDS) as a control group.Results: The incidence of severe hypoglycemia was highest in Group 1 (%10.8) and Group 2 and 3 had similar rates of severe hypoglycemia (0.8 and 0.7%, respectively). The incidence of polycythemia was 5.4% in Group 1 and was significantly higher than Group 3 (0.0%) while it was 2.3% in Group 2. Short stature (length < −2 SDS) ratio at the age of 1 and 2 years were similar in each group. Overweight/obesity ratio at the age of 1 were 9.5, 20.8 and 16.7% in each group, respectively (p = 0.509).Conclusion: This study was planned as a pilot study to determine potential differences in the problems of hypoglycemia, polycythemia, and growth according to the differences in definition. Short term disturbances such as hypoglycemia and polycythemia are found to be higher in infants with a BW SDS below −2. From this point of view, of course, it will not be possible to change the routine applications immediately, however this study will be an initiative for discussions by making long-term studies.

Safety and Efficacy of Clomiphene Citrate in the Treatment of Secondary Hypogonadism. A Retrospective Study

“Introduction: Clomiphene (Clomid) has an off-label indication to treat hypogonadism in select populations. “Based on clinical practice, this medication in certain types of hypogonadism is equally effective as testosterone in treating hypogonadism. It will lead to less side effects, lower treatment cost, and will decrease rates of infertility in the male veteran population.” Secondary hypogonadism can be most often caused by opioid use, obesity, sleep apnea, and diabetes.” “Aim of Study: To evaluate the safety and efficacy of Clomiphene Citrate in Treatment of Secondary Hypogonadism in comparison with testosterone. “Study Population: Data was obtained from the Veterans Administration Data Warehouse through the Veterans Administration Informatics and Computing Infrastructure. Data was extracted using SQL. There were 405,824 male patients with a diagnosis of hypogonadism (87.1%)and infertility (12.9%). nationally at the VA. Of these, 9566 patients have been treated with clomiphene citrate and 232,123 with various testosterone therapy. “ The two groups were then matched by propensity method to controls at a ratio of about 1:1 for Age, race, BMI and time for follow-up as potential confounding factors hat could have affected inclusion in the study controls. Patients without either Clomiphene or testosterone treatment were excluded. Statistical Analysis: SAS was used for propensity matching (PSM, greedy near) Categorical variables were evaluated as frequency counts with percentage within group, as well as ODDS ratio (OR) and differences were evaluated by a chi-square method. Comparisons of continuous variables were done were done by simple and paired t-test. Kaplan Meier plots and Cox Hazard ratio calculations were used to examine time dependent risk between treatments. Actual p-values are shown and p-values lower than 0.0001 are shown as such. All comparisons used a two-sided assumption. Measurements: Testosterone laboratory measures were recorded for start and end of trial. Survival was taken as the difference in days between start date and date of death. New diagnosis of Osteoporosis and Polycythemia was that which occurred after initiation of therapy. “Results: Clomid treatment normalized testosterone levels in 53.2% versus 46.8% in the testosterone group (OR 1.32 P<0.005). All-cause mortality was in the clomid group 0.16% and 1.62%in the testosterone group (OR 0.16 P<0.001). The incidence of new Osteoporosis for clomid was 3.9 % versus 5.9% for testosterone (OR 0.65 P<0.001)” Conclusion: This is a retrospective study comparing the efficacy and side effects of clomiphene versus testosterone for treatment of hypogonadism. The study showed that clomiphene is more effective than testosterone to treat secondary hypogonadism. We also found decreased overall mortality and incidence of polycythemia and osteoporosis.

Effects of delayed cord clamping in intrauterine growth-restricted neonates: a randomized controlled trial.

The time of cord clamping in intrauterine growth-restricted (IUGR) neonates remains an area of uncertainty. This assessor-blinded randomized controlled trial compared the effects of delayed cord clamping (DCC) with early cord clamping (ECC) on the systemic blood flow (SBF) and cerebral hemodynamics in IUGR neonates of gestational age ≥28 weeks, not requiring resuscitation. Eligible newborns were randomized to DCC (cord clamping after 60 s; n=55) or ECC (cord clamping within 30 s; n=55) group immediately after delivery. The primary outcome variable was superior vena cava (SVC) blood flow at 24±2 h. The secondary outcome variables were right ventricular output (RVO), anterior cerebral artery (ACA) blood flow velocity (BFV), superior mesenteric artery (SMA)-BFV and venous hematocrit at 24±2 h, peak total serum bilirubin (TSB), incidences of polycythemia, intraventricular hemorrhage, respiratory distress, feeding intolerance, and necrotizing enterocolitis, outcome, duration of hospital stay, screening audiometry, and serum ferritin levels at the postnatal age of 3 months. Compared to ECC, DCC was associated with significantly higher SVC flow (101.22±21.02 and 81.27±19.12 mL/kg/min, in DCC and ECC groups, respectively; p<0.0001), and significantly increased RVO, SMA-BFV, venous hematocrit, and serum ferritin levels. Though peak TSB was significantly higher with DCC, duration of phototherapy was comparable. ACA-BFV, incidence of polycythemia, and other outcomes were comparable between the groups.Conclusions: DCC was a safe and beneficial intervention in IUGR infants with an improved SBF and SMA-BFV and an increased hematocrit and serum ferritin levels without higher incidences of polycythemia and requirement of phototherapy for significant hyperbilirubinemia.Trial registration: Clinical Trials Registry of India (CTRI/2019/05/018904) What is Known: • Delayed cord clamping (DCC) increases superior vena cava (SVC) blood flow in preterm neonates. • DCC increases hematocrit and serum ferritin in intrauterine growth-restricted (IUGR) neonates, but there may be an associated risk of polycythemia and neonatal hyperbilirubinemia. What is New: • DCC increases SVC blood flow, right ventricular output, superior mesenteric artery blood flow velocity, venous hematocrit, and serum ferritin in IUGR neonates. • Incidences of polycythemia and duration of phototherapy for significant neonatal hyperbilirubinemia do not increase with DCC.

Comparison of Incidence of Neonatal Anemia in Different Timing of Delayed Cord Clamping; at 30 Seconds, 1 Minute and 2 Minutes in Term Vaginal Delivery: A Randomized Controlled Trial

Objective: To compare the effect of cord clamping time on the incidence of neonatal anemia, clinical outcomes, and maternal and neonatal complications in term vaginal delivered newborns. Materials and Methods: A randomized controlled study was undertaken. Two hundred forty healthy full term vaginal delivered newborns were randomly allocated to either 30-seconds, 1-minute, or 2-minutes groups (group 1, 2, and 3) of umbilical cord clamping. During the interval between delivery and cord clamping, the attendant held the neonate supine at the level of the introitus. Neonatal venous hematocrit (Hct) was measured at 48 to 72 hours after birth. Results: Two hundred thirty newborns completed the present study. Neonatal anemia (Hct less than 45%) was detected in six of 77 cases (7.8%) in group 1, five of 76 cases (6.6%) in group 2, and three of 77 case (3.9%) in group 3, and there were no significant differences among the groups. Mean venous hematocrit values at 48 to 72 hours of life ± standard deviations were 53.1±6.4% in group 1, 53.0±5.5% in group 2, and 53.0±5.7% in group 3. The incidence of polycythemia (hematocrit more than 65%) and neonatal jaundice were similar among all the groups. There were no significant differences in the estimated postpartum blood loss and other neonatal outcomes. Conclusion: Neonatal hematocrit was not significantly different following delayed cord clamping (DCC) at 30-seconds, 1-minute, and 2-minutes, but the incidence of neonatal anemia decreased with the longer timing of DCC. The estimated blood loss and other complications were not different between the groups. Therefore, a minimum of a one minute DCC should be considered for neonatal anemic prevention when compared with the 30-seconds DCC. Keywords: Delayed cord clamping, Timing, Hematocrit, Neonatal anemia

SAT-269 A Rare Case of Functioning Gonadotroph Producing Pituitary Macroadenoma in Teenage Male

Background: Unlike nonfunctioning gonadotroph pituitary adenomas, functioning gonadotroph pituitary adenomas (FGA) are an uncommon type of pituitary tumors that secrete biologically active gonadotropins (LH, FSH, or both). Clinical Case: A 23-year-old man with no previous medical history presented to the emergency department with three months history of progressive decreased vision and decreased libido. He denied headache, seizure, erectile dysfunction, or weakness. On physical examination, his visual acuity was significantly reduced on the right eye and was only able to perceive light. He had a visual field narrowing on the left eye. Gynecomastia was noted bilaterally and testicles were found to be enlarged (Orchidometer >25 mL). Complete blood count was significant for hemoglobin of 19.2 g/dL (N, 13.7-17.5 g/dL), and hematocrit of 57.0% (N, 40.1-51.0%). Pituitary function tests were as follow: FSH >200.0 mIU/mL (N, 1.5-12.4 mIU/mL), LH 17.0 mIU/mL (N, 1.7-8.6 mIU/mL), total testosterone 41.3 nmol/L (N, 8.6-29.0 nmol/L), free testosterone 1.263 nmol/L (N, 0.148-0.718 nmol/L), and bioavailable testosterone 29.609 (N, 2.110-8.920 nmol/L). Prolactin, TSH, GH, and ACTH were all within the normal range. Magnetic resonance imaging (MRI) showed a sellar mass involving the planum sphenoidal measuring 5.8 x 5.2 x 5.6 cm with optic chiasm displaced superiorly, in addition, subfalcine herniation with mild hydrocephalus was also noted. The patient underwent orbitozygomatic approach resection of the pituitary tumor. Histological examination was consistent with a pituitary adenoma. Cells stained positive for transcription factor steroidogenic factor 1 (SF 1), FSH, LH, and alpha-subunit consistent with a gonadotroph adenoma. They were negative for transcription factor Pit 1 stain and the remaining pituitary hormones including ACTH, GH, prolactin, and TSH stain. Postsurgical hormone assessment showed a significant decline in FSH and LH to 2.3 and 0.4 mIU/mL, respectively and testosterone level decreased to < 0.087 nmol/L on postoperative day 18. The patient’s vision improved postoperatively prior to discharge but he lost follow up thereafter. Conclusion: Most patients with functioning gonadotroph pituitary adenoma present with large tumors that are detected based on the occurrence of symptoms of compression that result from the enlarging sellar mass. Most patients, particularly men and postmenopausal women, do not develop symptoms of hormone excess and the lack of symptomatology results in delay in diagnosis. Our patients presented with significant polycythemia which resulted from excess testosterone and could have prompted earlier tumor detection if he had presented in an earlier stage. The incidence of polycythemia in male patients with functioning gonadotroph pituitary adenoma has previously been described in the literature in a few case reports.

Polycythemia in neonatal intensive care unit, risk factors, symptoms, pattern, and management controversy.

Background:Polycythemia (PC) is defined as venous hematocrit (hct) ≥65%. Its incidence is high among certain risk factors (RFs). Its management is controversy.Aims:To determine: (1) The incidence of PC in our neonatal intensive care unit (NICU). (2) Most common RF, symptoms, and laboratory abnormalities (LA) associated with PC and their effect on the length of hospital stay (LOS). (3) Whether noninvasive interventions are effective in reducing hct. (4) Hct pattern of PC neonates.Design:Retrospective cohort study.Setting:NICU at a maternity and children hospital.Materials and Methods:Records review of all neonates from March 2011 to August 2013. Inclusions criteria were: (1) Venous hct ≥65%. (2) Neonates born in our institution. (3) Early umbilical cord clamping. (4) Gestational age ≥34 weeks.Statistical Analysis:Chi-square and multiple regression analysis.Results:One hundred and one PC neonates were eligible. Incidence of PC in our NICU is 14.5%. The most common RF, symptoms, and LA were: Small for gestational age, jaundice and hypoglycemia respectively. Tachypnea ( P - 0.04) and oliguria (P - 0.03) significantly prolonged LOS. Noninvasive interventions or observation could not reduce the hct significantly (P - 0.24). The hcts mean peaked maximally at a mean of 2.8 h of age.Conclusion:PC incidence in our NICU is higher than the reported incidence in healthy newborns. Most of the PC neonates were either symptomatic or having LA. Noninvasive interventions or observation were not effective in reducing hct in polycythemic neonates. Hct in both healthy and PC neonates peaked at the same pattern.

The interpretation of measured red cell mass and plasma volume in patients with elevated PCV values.

Various formulae using both height and weight have been proposed to interpret measured red cell mass (RCM) and plasma volume (PV). This paper compares four different methods for evaluating these measurements in 50 males with PCV values above 0.51 and three different methods for evaluating results in 50 females with PCV values above 0.49. Overall there was close agreement in the RCM result expressions by all methods for both males and females except at extremes of height and/or weight. The incidence of absolute polycythaemia in both sexes was influenced by the width of the normal range. When this was taken into account overall the incidence of polycythaemia was similar, but in a small number of individuals there were discrepancies of interpretation. These individual patient differences establish that decisions regarding further investigations of a patient must not rest on a strict interpretation of a measured RCM. The various methods of measured PV interpretation gave dissimilar results--in particular by one of the male PV interpretation methods. The differences in the methods almost certainly reflect methodological discrepancies in the original techniques used to establish the normal values. The differences in result expression for PV would however lead to a different incidence of relative, low plasma volume, polycythaemia by the various techniques.

Blood Viscosity of the Neonate

After completing this article, readers should be able to: 1. List the determinants of blood viscosity in the neonate. 2. List the causes of polycythemia and hyperviscosity in the neonate. 3. List the signs, symptoms, and diagnostic criteria for polycythemia and hyperviscosity. 4. Describe steps for prevention and treatment of polycythemia and hyperviscosity in the neonate. Blood viscosity is defined as resistance to the movement of blood. In a circular vessel or tube, the resistance (R) increases with increasing viscosity (V) of the moving fluid and with the resistance resulting from the vessel geometry (Z): R=Z · V. Thus, blood viscosity describes the contribution of blood rheologic factors to blood flow resistance. However, blood viscosity depends on several factors, and the importance of these factors differs among various vessels. The major determinants of blood viscosity are the hematocrit, plasma viscosity, red blood cell (RBC) aggregation, RBC deformability, leukocyte properties, vessel diameter, and the shear forces acting on the RBC. (1) The hematocrit generally is assumed to be the most important determinant of blood viscosity. Blood viscosity rises exponentially with increasing hematocrit (Fig. 1). A marked rise in blood viscosity is seen when the hematocrit exceeds 0.65 L/L, which typically is defined as the threshold for hyperviscosity of the blood. However, in narrow arteries and arterioles and in capillaries, the plasma viscosity becomes the dominant determinant of blood viscosity. The fetal hematocrit increases from 0.33 L/L in the 12th week of gestation to 0.45 L/L in the 30th week and 0.50 L/L in the 40th week at term. At birth, the hematocrit may rise markedly as a result of “blood transfusion” from the placenta to the neonate. (2) A postnatal hematocrit of 0.45 to 0.65 L/L is considered normal in the healthy term neonate. Figure 1. Blood viscosity in tubes that have a diameter of 50 …

Diabetic fetal macrosomia: Significance of disproportionate growth

Fetal hyperinsulinism in infants of diabetic mothers (IDMs) produces increased fetal growth leading to macrosomia, which may or may not be proportionate. Disproportionate macrosomia refers to excessive weight characterized by a high weight/length ratio. We tested the hypotheses that (1) macrosomia in IDMs would be characterized by a high ponderal index (defined as weight/length ratio) and (2) infants with macrosomia who have a high ponderal index would have increased neonatal morbidity--specifically, hyperbilirubinemia, hypoglycemia, polycythemia, and acidosis. We studied 170 IDMs and 510 non-IDMs matched 1:3 for gestational age, race, and year of delivery. Forty-five percent of IDMs had macrosomia compared with 8% of control infants (p = 0.001), and 19% of IDMs had disproportionate macrosomia compared with 1% of control infants (p = 0.001). The rates of hyperbilirubinemia (p = 0.02), hypoglycemia (p = 0.01), and acidosis (p = 0.01) were greatest in infants with disproportionate macrosomia and least in nonmacrosomic infants. The incidence of polycythemia was not significantly different between the groups. We suggest that disproportionate macrosomia in the IDM is associated with an increased likelihood of neonatal complications.

Increasing Incidence of Anemia among Clinically ILL Georgia Broilers: 1988-89 vs. 1990

The incidence of anemia in clinically ill Georgia broilers climbed from 66.4% (324/488) during 1988-89 to 80.9% (531/656) during 1990. The incidence of polycythemia fell from 1.6% (8/488) during 1988-89 to 1.5% (10/656) during 1990. Specifically, compared with 1988-89, the 1990 incidence of anemia increased significantly in chicks at age 7 days (P = 0.0002) and 28 days (P = 0.05). We have no certain explanation for this shifting incidence of anemia in clinically ill Georgia broilers. Anemic chicks have plasma that contains virus particles with morphologic characteristics consistent with a virus (chicken anemia agent [CAA]) known to cause anemia in chickens. If CAA is the predominant etiology for anemia in clinically ill Georgia broilers, then our observation could be easily explained. The increasing rate of anemia could indicate a decline in broiler health over time.

Incidence of Anemia and Polycythemia in Clinically Ill Georgia Broilers

The incidence of anemia and polycythemia was established in clinically ill Georgia broilers that were tested for packed cell volume (PCV) during 1988 and 1989. More than 66% (324/488 = 66.4%) of PCV-tested broiler chicks were anemic, and less than 2% (8/488 = 1.6%) of PCV-tested chicks were polycythemic. The incidence of anemia was significantly (P less than 0.001) higher than expected (2.5%) at age 7 days (56.9%), 14 days (83.9%), 21 days (74.7%), 28 days (58.7%), and 35 days (57.9%). The incidence of polycythemia was significantly (P less than 0.001) higher than expected (2.5%) in 35-day-old broilers (21.1%) but was not significantly different from the expected rate in broilers at age 7 days (0%), 14 days (1.8%), 21 days (0.3%), and 28 days (4.3%). The established rates for anemia were much higher than we would have hypothesized. This led us to believe that either 1) an etiology for anemia is present in epizootic proportions in Georgia broilers, or 2) the standard method for establishing reference intervals for anemia in animals does not apply to broiler chicks.

Down's Syndrome-Transient Abnormal Myelopoiesis and Acute Leukaemia.

Subjects with Down's syndrome have an increased risk, particularly during childhood, of developing acute leukaemia. There is an increased incidence both of acute lymphoblastic leukaemia and of acute myeloid leukaemia (AML), particularly acute megakaryoblastic leukaemia, often presenting with the clinical features of acute myelofibrosis. In addition neomates with Down's syndrome show a high incidence of polycythaemia and may also develope a syndrome simulating acute leukaemia, commonly designated transient abnormal myelopoiesis (TAM). Although TAM closely resembles acute leukaemia there are some subtle differences and infants who survive four to eight weeks usually show a complete remission. Subsequently a significant proportion of these infants develop AML usually around the age of 2 to 3 years. Cytogenetic evidence indicates that in at least some neonates with TAM the abnormal cells are monoclonal. The presence of a cytogenetically abnormal clone is not incompatible with subsequent complete remission with loss of the abnormal close and long survival. For these reasons it may be justifiable to regard TAM as transient acute myeloid leukaemia. Although other lineages are also involved in TAM the blast cells are usually predominantly megakaryoblasts. This, together with the predominance of megakaryoblastic leukaemia among cases of AML in Down's syndrome, suggests that abnormal proliferation of megakaryoblasts in specifically linked to the presence of a supernumerary chromosome 21. Further support for this hypothesis is provided by cases of TAM in subjects with mosaicism for trisomy 21 or for a related abnormality of chromosome 21; the abnormal proliferating cells are derived from the cytogenetically abnormal population. Additional factors are clearly necessary for the occurrence of TAM or AML in subjects with Down's syndrome but their nature is as yet unknown.

Neonatal Hyperviscosity: I. Incidence

Capillary hematocrits were performed on 790 infants during the first four hours after birth. These infants were delivered between August 8 and December 7, 1974, at the University of Colorado Medical Center, which is at an altitude of 1,061 m above sea level. When the capillary hematocrit was 7% or greater, venous hematocrit and blood viscosity were determined. Capillary hematocrits obtained from warmed heels in the first hour after birth were spuriously high and not consistently related to venous hematocrit. Venous polycythemia, defined as a hematocrit of 65% or greater, occurred in 4% of the newborn population. Hyperviscosity (greater than 2 SD above the mean for newborns) occurred in 5% of the newborn infants. At a venous hematocrit of 65% or greater, hyperviscosity was predictable, but some infants with venous hematocrits between 60% and 64% also had hyperviscosity of the blood. The incidence of polycythemia and hyperviscosity was further related to birth weight and gestational age. The infants who were small for gestational age were at highest risk of polycythemia and hyperviscosity, followed by infants who were large for gestational age. However, the greatest number of infants with hyperviscosity were term appropriate for gestational age. Preterm infants with gestational ages of less than 34 weeks were not affected.