Polycythemia

Polycythemia is defined by venous hemoglobin concentration > 220 g/l or by hematocrit value > 0.65 during the first week of life. It correlates clinically with hyperviscosity syndrome.

The common causes:

• chronic intrauterine hypoxia
• twin-twin transfusion syndrome in monochorionic-diamniotic twins (recipient twin)
• excessive placental transfusion

Diagnosis

Clinical signs

• dictated by the severity of hyperviscosity syndrome (infant can be completely asymptomatic)
• respiratory distress syndrome (RDS)
• cardiac failure
• seizures
• thrombotic complications
• hypoglycemia
• hyperbilirubinemia

Laboratory findings

• venous hemoglobin concentration > 220 g/l or hematocrit value > 0.65 during the first week of life

Therapy

General

• treatment for individual symptoms
• parenteral fluids (hypoglycemia, jaundice)
• careful enteral nutrition (variable perfusion of gastrointestinal tract)

Specific

• partial exchange transfusion => reduce hematocrit < 0.60

References

① Sarkar S, Rosenkrantz TS. Neonatal polycythemia and hyperviscosity. Semin Fetal Neonatal Med. 2008;13(4):248-255. doi:10.1016/j.siny.2008.02.003