Severe neonatal anemia: looking at the whole picture

Abstract

Neonatal anemia is an important cause of newborn morbimortality. Its causes fall into three categories: hemorrhagic, hemolytic or hypoplastic. Prompt recognition and acute care are crucial for good outcomes. Its etiological investigation is also essential to prevent further complications for the newborn and its mother.

We report a case of a full-term neonate born after an uneventful pregnancy of a mother with a significant medical history of ulcerative colitis under mesalazine treatment. He was delivered by an emergency c-section for a non-reassuring fetal status with an Apgar score of 5-8-9. Investigation revealed severe neonatal anemia with high reticulocyte count and a positive Kleihauer-Betke test. After an effective blood transfusion, he was discharged home under iron supplementation and later reevaluations showed normalization of blood parameters and regular growth and neurodevelopment.

Many causes of neonatal anemia have been described. The presence of fetal erythrocytes in maternal blood occurs in nearly all term pregnancies, but massive fetomaternal hemorrhage occurs only in 0.5% of cases. Active inflammatory bowel disease is also associated with adverse pregnancy outcomes and, in recent years, mesalazine, one of its main treatments, has been linked to neonatal anemia and hydrops fetalis. Regardless of the patient’s clinical presentation and predicted anemia etiology, we highlight the importance of identifying and acting on further possible causes.