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Anemia of Prematurity. Treatment options for a 3 month old preterm who has Hb of 6 gm%.

Anemia of Prematurity:

Etiophysiology:

1. Physiological:
@birth, considerable more O2 availability ➵ Hb-oxygen saturation  ↑es from 50% to 95%.
+
Gradual switch from HbF to low affinity HbA ➵ ↑ O2 delivery capability.
⇓
↑Blood O2 content + ↑ delivery ➵ ↓ EPO production
⇓
Hb declines rapidly upto 7-9gm/dl by 3-6wk age.
2. P.T are also prone to have multiple phlebotomies for sampling.
3. P.T site of production of EPO is liver, relatively insensitive to hypoxia than kidney

Prevention:

1. Delayed cord clamping, umbilical cord milking @birth.
2. Reduce unnecessary phlebotomies

Treatment options for a 3 month old preterm who has Hb of 6 gm%:

Assessment:

Infants are to be assessed and categorised into
  1. Stable infants
  2. Unstable infants

1. Stable infants:

these are infants who are 
  • feeding well and 
  • growing normally

2. Unstable infants:

These are infants who are
  • hemodynamically unstable(abnormal H.R)
  • poor weight gain
  • respiratory difficulties

Management:

Stable Infants:

  • Iron therapy:
    • starting @ 1 mo age to 1 yrs
    • starting dose : 1-2mg/kg/day
    • upto 3-6mg/kg/day
  • Follow up

Unstable infants:

  • Admission
  • Blood transfusion 
    • 10-15ml/kg
    • Split unit from single donor for sequential transfusions (↓ donor exposure)
  • Avoid unnecessary phlebotomies
  • EPO
    • May be used
    • Not recommended universally


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