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What is physiologic anemia of infancy? Discuss its etiology, characteristics and management.

Physiological Anemia of Infancy

  • At birth infants bhave higher Hb & larger RBC. 
  • 1st week - progressive decline of Hb begins
  • Persists for 6-8 wk
Resulting Anemia is physiological anemia of Infancy.

Etiology:

@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
⇓
Suppression of erythrpoiesis
⇓
No replacement of removed RBC
⇓
Anemia

Characteristics:

Term infant:

Hb continues to fall untill tissue O2 requirement > O2 delivery
This point is reached
  • about 11g/dl
  • between 8-12wks of age
EPO production is stimulated & erythropoiesis resumes.
Iron stored in RES from degraded RBC is sufficient for this untill 20wks age.

Preterm Infant:

Physiology remains the same, except Hb decline is more extreme and rapid.
  • Reaches 7-9g/dl
  • By 3-6wks age
There is suboptimal erythropoietic response
  • In fetal life EPO production is handled by Liver
  • Liver's oxygen sensor is relatively insensitive to hypoxia compared to kidney
  • Preterm delivery does not accelerate switching of EPO production from liver to kidney
  • Additionally there is accelerated metabolism of EPO in preterms

Treatment:

Full term infants generally requires no therapy other than ensuring infant diet has essential nutrients for normal hematopoiesis.
In preterms, no Hb cut off for transfusion should be assessed & managed.

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 (with Fe)
    • May be used
    • Not recommended universally

Preventive measures:

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

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