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Infant have jaundice. Blood test showed Hb 6 and thallesemia test negative. Should I be concerned?

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Pediatrician, Neonatology
Practicing since : 1970
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Dear Sir,

My wife delivered a baby girl on 24.08.2012 at 28 weeks. Her weight was 1.22 kgs. at birth which reduced to 900 gms. during subsequent week in NICU. Initially grunting was there for a day or two after birth for which baby was kept on oxygen. During second/third week after birth, the baby developed jaundice & was kept on phototherepy. After a week or two, baby was being fed with the mother's milk through feeding tube & the dose was slowly increased to 24ml four times a day. Now the baby is being breastfed four hourly from 22.11.2012.

The Hb. at birth was 13.7 gms/dl which reduced to 8 gms/dl app. in first week of Oct'12. Hence 10ml Blood( B+) from father was transfused on 05.10.2012 & 12.10.2012 each & the Hb. level was elevated to 12+ gms./dl.

The doctor at NICU discharged the baby on 18.10.2012 with 1.28 kgs. wt. & said that the baby is OK & will slowly gain weight and become normal at 2 to 3 years of age. First immunisation is only to be given at 1.75 gms. of wt. only as suggested by the doctor.

A blood test of the baby was done again on 23.11.2012(Baby Wt.-1.55 kg.) & the Hb. was found to be 6 gms./dl. Thallesemia test is negative. Blood transfusion was done again with 15ml blood from the blood bank.

Kindly let me know the reasons for decrease in Hb. level & further coarse of remedial action. Is it a cause of great concern?
Posted Wed, 19 Dec 2012 in Growth and Development in Children
 
 
Answered by Dr. Uma Rajah Ananth 6 hours later
Hi,
Welcome to HCM!

Reg your pre term baby ,

I have a few questions to begin with.

1- what is the blood group of mother and baby?

2 was G6pd tested for?

3 what was the Hb at discharge?


She started with a low hemoglobin of 13 gms.
The first few transfusions are accepted because there would have been blood extractions from the baby for various important tests at that time.

At 23/11, the corrected age was like term.
At this time a drop to 6 GM is strange.!
Only 15 ml packed cells at that time is not enough.
It would have raised the hb to only 8-9 gms.v
I have a feeling she may need again . Vt


There are many reasons for anemia other than thalassemia!
G6 pd , other hemolytic anemia,may be the reason.
Or it may be the simple reason that doctors did not want to give many transfusions and hb was never raised back to atleast12-13 gms after the first fall.
Complete investigations are not possible now because the baby received blood .
We have to wait and watch.

Hope you are giving iron drops along with breast milk.

All the best
God bless
Dr Uma
Above answer was peer-reviewed by
 
Follow-up: Infant have jaundice. Blood test showed Hb 6 and thallesemia test negative. Should I be concerned? 2 days later
Respected Doctor,

Thanks for your earliest reply. I have written all the details below once again after going through the reports & the prescriptions of the attending doctor at Patna. All the Prescriptions & the Reports have been uploaded to my account. Kindly go through these reports. The latest Thalessemia Profile & Serum Calcium reports are also attached herewith for your kind reference.

1. The Blood Group of the Mother, Father & the Baby are all B+.
2. G6pd Test has not been done.
3. Hb. just before the discharge on 18.10.2012 was not tested. However the Hb. after first blood transfusion of 10ml was 10.73 gms./dl on 09.10.2012. After that, second blood transfusion of 10ml was done on 12.10.2012.

My wife XXXXXXX XXXXXXX has delivered a baby girl on 24.08.2012 at 28 weeks. Her weight was 1.22 kgs. at birth which reduced to 900 gms. during subsequent week in NICU at Patna. Initially grunting was there for a day or two after birth for which baby was kept on oxygen. During first week after birth, the baby developed physiological jaundice & was kept on phototherepy. After a week or two, the baby was started being fed with the mother's milk through feeding tube & the dose was slowly increased to 24ml four times a day. Now the baby is being breastfed four hourly from 22.11.2012.

The Hb. of the baby at birth was 13.78 gms/dl which reduced to 8.7 gms/dl on 04.10.2012. Hence 10ml Blood( B+) from father was transfused on 05.10.2012 & 12.10.2012 each & the Hb. level was elevated to 10.73 gms./dl on 09.10.2012. After blood transfusion on 12.10.2012 Hb. test was not done.

The doctor at NICU discharged the baby on 18.10.2012 with 1.18 kgs. wt. & said that the baby is OK now & will slowly gain weight and become normal at 2 to 3 years of age. First immunisation is only to be given at 1.75 gms. of wt. only as suggested by the doctor & the date for the First Immunisation has been fixed on 05.12.2012.

A blood test for Thallesemia Profile & Serum Calcium of the baby was done on 23.11.2012 (Baby Wt.-1.6 kg.) & the Hb. was found to be 6 gms./dl.. Blood transfusion was done again with 16ml blood from the blood bank.

All the Prescription & all the relevent Test Reports are attached herewith for your kind reference. This is also to be noted that my wife has delivered a baby girl earlier at CMCH on 28.09.2009 after IVF at RMU. The second issue has been conceived normally & was delivered prematurely on 24.08.2012 at 28 weeks reason being water discharge.

Kindly let me know the reasons for decrease in Hb. level & further coarse of remedial action for Hb. increase, Weight gain & normal developement of the baby. Kindly advise accordingly.

Thanks & Regards,
XXXXXXX XXXXXXX
Mob No.-0000

 
 
Answered by Dr. Uma Rajah Ananth 4 hours later
Hello XXXXXXX XXXXXXX
Thanks for the details.!

I went through the attachments !

The first drop in hub is expected and happens due to some blood tests that are needed in the early stages.

The second drop in hb from 10.7 gms on 12 /10 to 6 gms
on 24/11 is bit worrying.
This also can be explained by factors
1 blood extractions after previous transfusion which can not be avoided,
2--erythropoietin deficiency which is common in pre term babies,
3- natural course of newborns to drop hb round about 12 weeks after birth

Anyway at that time the baby recd 16 ml blood only.
This would have increased the hb to about 8-9 gms only.
At this stage ,personally I would have preferred one more transfusion to raise the hb to atleast 10-11 gms.!
He may need one more transfusion probably soon.
The baby will need one more hb check up within a week or 10 days.

Anyway if the baby is growing well and gaining weight,do not worry.
Give some iron drops o.3 ml once a day if not already given by your doctor.
Let us wait and see how the baby maintains hb.

Reg the baby at home,be very careful to avoid infections.
Continue breast milk.
We will wait and see .
Till then do not worry.

Good luck
Dr Uma
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