What is anemia?

Red blood cells (RBCs) are one of the types of cells present in our blood. RBCs have a very important role in carrying the oxygen that we breathe into our lungs to the cells of the body where oxygen is used for energy. When a person does not have enough RBCs in their body we call this ‘anemia’. At some critical level of anemia, the cells of the body do not function very well. Anemia may occur in babies, children, and adults for a variety of reasons.

Premature infants, in general, have a diminished ability to make new red blood cells. As in older infants, children and adults, the red blood cells of premature infants go through the normal process of aging and dying. However, the bone marrow (the space in the middle of long bones where new blood cells are made) of premature infants is not as efficient at replacing the dying red blood cells and often can not “keep up” with the continual normal process of cell “turnover”. This process may result in anemia.

Additionally, when infants are critically ill at birth (whether premature or full-term) they require lots of monitoring and, often times, many interventions from physicians and nurses to support their breathing and provide them with nutrition so that they continue to grow and get better. Many of these interventions require that blood samples be taken from the baby so that appropriate adjustments can be made. In these critically ill infants frequent blood samples make the bone marrow even less capable of making enough new red blood cells. This can also result in anemia.

What are the signs and symptoms of anemia?

When anemia becomes significant for an infant it may result in

• low blood pressure
• fast heart rate
• increased breathing problems
• more pauses in the breathing (apnea)
• poor tolerance of feedings
• poor weight gain
• fatigue
• difficulty nipple feeding

How is anemia diagnosed?

Anemia is diagnosed by taking a sample of your baby’s blood and testing it for the “red blood cell count” or hematocrit. An infant with a hematocrit value that is less than the normal for their age is considered anemic.

Your baby’s physicians do not decide to treat anemia based solely on a hematocrit value. The decision to treat anemia is based on each individual baby, the signs or symptoms of anemia the baby may have (if any), and how ill the baby is at the time.

How is anemia treated?

The immediate treatment for severe anemia is a red blood cell transfusion. Your baby’s doctors carefully consider the benefits and risks to an infant before making a decision to transfuse any blood product. Your baby’s doctors also work closely with the Blood Bank to ensure that babies who need blood products are exposed to as few donors as possible.

The blood products used in this hospital are collected from volunteer donors by the American Red Cross. Some parents wish to provide their infants with blood from their own family members or friends. This is termed ‘Direct Donation’ and must be arranged by the family.

The initial need for a blood transfusion may arise in the first days to week of life. Additional transfusions may be needed for weeks thereafter, even just before discharge. In general, the smallest and most critically ill infants receive the greatest number of transfusions. Many healthier premature infants, however, never require a transfusion.

Your baby’s doctors will explain the risks and benefits of blood transfusions to you and obtain your consent for this procedure before your baby’s first transfusion. They will also make every attempt to notify you whenever your baby needs additional blood transfusions, if you wish.

If your baby develops anemia, he/she will also be started on oral iron therapy (Fer-in-sol drops or a multi-vitamin with iron) while in the hospital. Iron is needed by the body to make RBCs. Iron therapy is often continued after infants are discharged home. Prior to discharge, parents are taught how to give all medications by the nursing staff in the NICU. It is very important that your baby continue to receive these medications after going home so that their bodies continue to make new RBCs and their anemia improves.