Download PDF
Am J Perinatol 2011; 28(7): 557-564
DOI: 10.1055/s-0031-1274504
© Thieme Medical Publishers

Partial Exchange Transfusion for Polycythemia Hyperviscosity Syndrome

Bridget Hopewell1 , Laurie A. Steiner2 , Richard A. Ehrenkranz2 , Matthew J. Bizzarro2 , Patrick G. Gallagher2 , 3
  • 1Yale University School of Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 2Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
  • 3Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
Further Information

Publication History

Received: October 6, 2010. Accepted after revision: January 4, 2011.

Publication Date:
01 March 2011 (online)

Also available at
    Permissions and Reprints

ABSTRACT

The objective of this study was to examine the use of partial exchange transfusion (PET) performed for polycythemia hyperviscosity syndrome (PHS) over time. A retrospective review of 141 infants who received a PET for PHS at Yale–New Haven Hospital between 1986 and 2007 was performed, querying maternal and neonatal medical records. Patient demographics, risk factors for PHS, indications for PET, and complications associated with PET and PHS were collected. Overall, there was no change in the number of PET performed over the study period (r 2 = 0.082, p = 0.192). Eighty-eight percent of patients had at least one risk factor for PHS, most commonly maternal diabetes. Over time, there was a statistically significant decrease in maternal diabetes as a risk factor for PHS. Forty percent of patients had a significant complication attributed to PHS prior to PET. Eighteen percent of patients had a complication attributed to PET. Life-threatening complications of PHS or PET were rare. In conclusion, PHS continues to be a problem observed in neonatal intensive care units, particularly in at-risk populations. PHS and PET are associated with significant complications. Well-designed studies with long-term follow up are needed to assess the risks and benefits of PET for PHS.

KEYWORDS

Hematocrit - reduction exchange - neonate - complication

REFERENCES

  • 1 Ramamurthy R S, Brans Y W. Neonatal polycythemia: I. Criteria for diagnosis and treatment.  Pediatrics. 1981;  68 168-174
    PubMedGoogle Scholar
  • 2 Stevens K, Wirth F H. Incidence of neonatal hyperviscosity at sea level.  J Pediatr. 1980;  97 118-119
    PubMedGoogle Scholar
  • 3 Wirth F H, Goldberg K E, Lubchenco L O. Neonatal hyperviscosity: I. Incidence.  Pediatrics. 1979;  63 833-836
    PubMedGoogle Scholar
  • 4 Wiswell T E, Cornish J D, Northam R S. Neonatal polycythemia: frequency of clinical manifestations and other associated findings.  Pediatrics. 1986;  78 26-30
    PubMedGoogle Scholar
  • 5 Shohat M, Merlob P, Reisner S H. Neonatal polycythemia: I. Early diagnosis and incidence relating to time of sampling.  Pediatrics. 1984;  73 7-10
    PubMedGoogle Scholar
  • 6 Katz J, Rodriguez E, Mandani G, Branson H E. Normal coagulation findings, thrombocytopenia, and peripheral hemoconcentration in neonatal polycythemia.  J Pediatr. 1982;  101 99-102
    PubMedGoogle Scholar
  • 7 Sarkar S, Rosenkrantz T S. Neonatal polycythemia and hyperviscosity.  Semin Fetal Neonatal Med. 2008;  13 248-255
    CrossrefPubMedGoogle Scholar
  • 8 Wiedmeier S E, Henry E, Christensen R D. Hematological abnormalities during the first week of life among neonates with trisomy 18 and trisomy 13: data from a multi-hospital healthcare system.  Am J Med Genet A. 2008;  146 312-320
    PubMedGoogle Scholar
  • 9 Rosenkrantz T S. Polycythemia and hyperviscosity in the newborn.  Semin Thromb Hemost. 2003;  29 515-527
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Yao A C, Moinian M, Lind J. Distribution of blood between infant and placenta after birth.  Lancet. 1969;  2 871-873
    PubMedGoogle Scholar
  • 11 Lopriore E, Oepkes D. Fetal and neonatal haematological complications in monochorionic twins.  Semin Fetal Neonatal Med. 2008;  13 231-238
    CrossrefPubMedGoogle Scholar
  • 12 Black V D. Neonatal hyperviscosity syndromes.  Curr Probl Pediatr. 1987;  17 73-130
    PubMedGoogle Scholar
  • 13 Bada H S, Korones S B, Kolni H W et al.. Partial plasma exchange transfusion improves cerebral hemodynamics in symptomatic neonatal polycythemia.  Am J Med Sci. 1986;  291 157-163
    CrossrefPubMedGoogle Scholar
  • 14 Rosenkrantz T S, Oh W. Cerebral blood flow velocity in infants with polycythemia and hyperviscosity: effects of partial exchange transfusion with Plasmanate.  J Pediatr. 1982;  101 94-98
    PubMedGoogle Scholar
  • 15 Swetnam S M, Yabek S M, Alverson D C. Hemodynamic consequences of neonatal polycythemia.  J Pediatr. 1987;  110 443-447
    PubMedGoogle Scholar
  • 16 Norman M, Fagrell B, Herin P. Effects of neonatal polycythemia and hemodilution on capillary perfusion.  J Pediatr. 1992;  121 103-108
    PubMedGoogle Scholar
  • 17 Bada H S, Korones S B, Pourcyrous M et al.. Asymptomatic syndrome of polycythemic hyperviscosity: effect of partial plasma exchange transfusion.  J Pediatr. 1992;  120 (4 Pt 1) 579-585
    PubMedGoogle Scholar
  • 18 Dempsey E M, Barrington K. Short and long term outcomes following partial exchange transfusion in the polycythaemic newborn: a systematic review.  Arch Dis Child Fetal Neonatal Ed. 2006;  91 F2-F6
    PubMedGoogle Scholar
  • 19 Murphy Jr D J, Reller M D, Meyer R A, Kaplan S. Effects of neonatal polycythemia and partial exchange transfusion on cardiac function: an echocardiographic study.  Pediatrics. 1985;  76 909-913
    PubMedGoogle Scholar
  • 20 Murphy Jr D J, Reller M D, Meyer R A, Kaplan S. Left ventricular function in normal newborn infants and asymptomatic infants with neonatal polycythemia.  Am Heart J. 1986;  112 542-547
    CrossrefPubMedGoogle Scholar
  • 21 Black V D, Lubchenco L O, Koops B L, Poland R L, Powell D P. Neonatal hyperviscosity: randomized study of effect of partial plasma exchange transfusion on long-term outcome.  Pediatrics. 1985;  75 1048-1053
    PubMedGoogle Scholar
  • 22 Ozek E, Soll R, Schimmel M S. Partial exchange transfusion to prevent neurodevelopmental disability in infants with polycythemia.  Cochrane Database Syst Rev. 2010;  (1) CD005089
    PubMedGoogle Scholar
  • 23 Werner E J. Neonatal polycythemia and hyperviscosity.  Clin Perinatol. 1995;  22 693-710
    PubMedGoogle Scholar
  • 24 American Academy of Pediatrics Committee on Fetus and Newborn . American Academy of Pediatrics Committee on Fetus and Newborn: routine evaluation of blood pressure, hematocrit, and glucose in newborns.  Pediatrics. 1993;  92 474-476
    PubMedGoogle Scholar
  • 25 Battaglia F C, Marconi A M. The new obstetrics: its integration into neonatal clinical practise, teaching and research.  J Perinat Med. 1997;  25 399-405
    CrossrefPubMedGoogle Scholar
  • 26 Johnstone F D, Lindsay R S, Steel J. Type 1 diabetes and pregnancy: trends in birth weight over 40 years at a single clinic.  Obstet Gynecol. 2006;  107 1297-1302
    CrossrefPubMedGoogle Scholar
  • 27 Mimouni F, Tsang R C, Hertzberg V S, Miodovnik M. Polycythemia, hypomagnesemia, and hypocalcemia in infants of diabetic mothers.  Am J Dis Child. 1986;  140 798-800
    PubMedGoogle Scholar
  • 28 Cordero L, Treuer S H, Landon M B, Gabbe S G. Management of infants of diabetic mothers.  Arch Pediatr Adolesc Med. 1998;  152 249-254
    PubMedGoogle Scholar
  • 29 Awonusonu F O, Pauly T H, Hutchison A A. Maternal smoking and partial exchange transfusion for neonatal polycythemia.  Am J Perinatol. 2002;  19 349-354
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Bateman D A, O'Bryan L, Nicholas S W, Heagarty M C. Outcome of unattended out-of-hospital births in Harlem.  Arch Pediatr Adolesc Med. 1994;  148 147-152
    CrossrefPubMedGoogle Scholar
  • 31 Hutton E K, Hassan E S. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.  JAMA. 2007;  297 1241-1252
    CrossrefPubMedGoogle Scholar
  • 32 Kugelman A, Borenstein-Levin L, Riskin A et al.. Immediate versus delayed umbilical cord clamping in premature neonates born <35 weeks: a prospective, randomized, controlled study.  Am J Perinatol. 2007;  24 307-315
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Miller M, Cosgriff J M. Hematological abnormalities in newborn infants with Down syndrome.  Am J Med Genet. 1983;  16 173-177
    CrossrefPubMedGoogle Scholar
  • 34 Rosenberg A. The IUGR newborn.  Semin Perinatol. 2008;  32 219-224
    CrossrefPubMedGoogle Scholar
  • 35 Usher R, Shephard M, Lind J. The blood volume of the newborn infant and placental transfusion.  Acta Paediatr. 1963;  52 497-512
    CrossrefPubMedGoogle Scholar
  • 36 Weinblatt M E, Fort P, Kochen J, DiMayio M. Polycythemia in hypothyroid infants.  Am J Dis Child. 1987;  141 1121-1123
    PubMedGoogle Scholar
  • 37 Alexander G R, Himes J H, Kaufman R B, Mor J, Kogan M. A United States national reference for fetal growth.  Obstet Gynecol. 1996;  87 163-168
    CrossrefPubMedGoogle Scholar
  • 38 Dempsey E M, Barrington K. Crystalloid or colloid for partial exchange transfusion in neonatal polycythemia: a systematic review and meta-analysis.  Acta Paediatr. 2005;  94 1650-1655
    CrossrefPubMedGoogle Scholar
  • 39 Lambert D K, Christensen R D, Henry E et al.. Necrotizing enterocolitis in term neonates: data from a multihospital health-care system.  J Perinatol. 2007;  27 437-443
    CrossrefPubMedGoogle Scholar
  • 40 Wiswell T E, Robertson C F, Jones T A, Tuttle D J. Necrotizing enterocolitis in full-term infants. A case-control study.  Am J Dis Child. 1988;  142 532-535
    PubMedGoogle Scholar
  • 41 Walsh M C, Kliegman R M, Fanaroff A A. Necrotizing enterocolitis: a practitioner's perspective.  Pediatr Rev. 1988;  9 219-226
    CrossrefPubMedGoogle Scholar
  • 42 Linderkamp O. Blood viscosity of the neonate.  Neoreviews. 2004;  5 e406-e416
    CrossrefPubMedGoogle Scholar
  • 43 Ratrisawadi V, Plubrukarn R, Trakulchang K, Puapondh Y. Developmental outcome of infants with neonatal polycythemia.  J Med Assoc Thai. 1994;  77 76-80
    PubMedGoogle Scholar
  • 44 Goldberg K, Wirth F H, Hathaway W E et al.. Neonatal hyperviscosity. II. Effect of partial plasma exchange transfusion.  Pediatrics. 1982;  69 419-425
    PubMedGoogle Scholar
  • 45 Black V D, Lubchenco L O, Luckey D W et al.. Developmental and neurologic sequelae of neonatal hyperviscosity syndrome.  Pediatrics. 1982;  69 426-431
    PubMedGoogle Scholar
  • 46 Wong W, Fok T F, Lee C H et al.. Randomised controlled trial: comparison of colloid or crystalloid for partial exchange transfusion for treatment of neonatal polycythaemia.  Arch Dis Child Fetal Neonatal Ed. 1997;  77 F115-F118
    CrossrefPubMedGoogle Scholar
  • 47 Linderkamp O, Versmold H T, Riegel K P, Betke K. Contributions of red cells and plasma to blood viscosity in preterm and full-term infants and adults.  Pediatrics. 1984;  74 45-51
    PubMedGoogle Scholar
  • 48 Dintenfass L. Blood viscosity, internal fluidity of the red cell, dynamic coagulation and the critical capillary radius as factors in the physiology and pathology of circulation and microcirculation.  Med J Aust. 1968;  1 688-696
    PubMedGoogle Scholar
  • 49 Rand P W, Austin W H, Lacombe E, Barker N. pH and blood viscosity.  J Appl Physiol. 1968;  25 550-559
    PubMedGoogle Scholar
  • 50 Bergqvist G. Letter: hyperviscosity in the neonate.  J Pediatr. 1974;  84 611-612
    PubMedGoogle Scholar
  • 51 Drew J H, Guaran R L, Grauer S, Hobbs J B. Cord whole blood hyperviscosity: measurement, definition, incidence and clinical features.  J Paediatr Child Health. 1991;  27 363-365
    CrossrefPubMedGoogle Scholar

Patrick G GallagherM.D. 

Department of Pediatrics, Yale University School of Medicine

333 Cedar Street, P.O. Box 208064, New Haven, CT 06520-8064

Email: patrick.gallagher@yale.edu