Polycythemia - high viscosity
Introduction
Introduction Polycythemia-high viscosity syndrome is a common disease in the neonatal period. Due to increased red blood cells, blood viscous, slow blood flow, it is easy to cause poor perfusion and hypoxia, as well as damage to heart, brain and kidney. Organs can partially affect the long-term prognosis of the nervous system. Hematocrit, red blood cell deformation and plasma viscosity determine the whole blood viscosity, but the most important is hematocrit. When it is below 0.60~0.65 (60%~65%), the blood cell ratio The volume is linearly related to blood viscosity, and if it is increased, it is exponentially correlated.
Cause
Cause
The causes can be divided into active and passive types.
1. Active type: including small for gestational age, expired birth, mother with pre-eclampsia, severe heart disease, smoking and prenatal medication (such as propranolol). Other conditions that lead to an increase in the concentration or viability of erythropoietin may also occur. For example, the mother has gestational diabetes, the child is congenital, 13 or 18 trisomy syndrome, congenital thyrotoxicosis, congenital. Adrenal hyperplasia is too long and Beckwith syndrome.
2. Passive type: occurs in the fetus receiving red blood cell transfusion, the most common cause of normal term infants is delayed umbilical cord ligation.
Examine
an examination
Related inspection
Blood test blood routine
Laboratory examination
After 12 hours of birth, venous hemoglobin (Hb) 220g / L red blood cells (RBC) > 7.0 × 1012 / L, hematocrit (HCT) > 0.65 or 2 times peripheral blood capillary hematocrit (HCT) > 0.70 (centrifugation The speed should be 3,500 rpm and last for 30 minutes to avoid false positives.) When the above three indicators are not completely consistent, the most important indicator is hematocrit (HCT), followed by hemoglobin (Hb). As long as hematocrit (HCT) is consistent with hemoglobin (Hb), only hemoglobin (Hb) can be diagnosed. Those should review it in the short term. Twin-child blood transfusion, the first delivery is mostly recipients, often this disease, and the fetal hemoglobin difference greater than 50g / L, can be diagnosed.
2. Other auxiliary inspections
(1) X-ray film
Can understand the cardiopulmonary condition of the child, can find the increase in the ratio of heart to chest, chest congestion and other changes.
(2) Echocardiography
Visible heart function decline.
(3) Brain CT scan
See multifocal infarction, cerebral hemorrhage and water-borne brain abnormalities.
(4) ECG examination
The ST segment of right atrial hypertrophy and left ventricular hypertrophy can be found.
Diagnosis
Differential diagnosis
Patients with clear central nervous system damage should be differentiated from intracerebral hemorrhagic disease; the same blood viscosity increases to microthrombus formation, consumption of clotting factors and platelets, and bleeding should be differentiated from hemorrhagic diseases; , necrotizing enterocolitis and other identification of the appearance of more blood and laboratory tests can help identify.
