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A 1 week old presents with multiple bouts of hematemesis. The baby was born full-term, no complication, has been breast-feeding normally, and is afebrile. The baby is nontoxic, has normal vital signs and perfusion, and has a normal physical examination. Point of care hemoglobin is 15 g/dL.
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December 11, 2018 at 11:40 am
A) Apt test
The Apt test is used to differentiate (swallowed) maternal from fetal/infant blood. Fetal hemoglobin is more resistant to alkali than adult hemoglobin. Blood from vomitus or stool is mixed with NaOH – fetal Hb stays pink whereas adult Hb is converted to hematin by the NaOH, and turns yellow-brown in color. The infant may be swallowing maternal blood from bleeding nipples during breastfeeding. Because the baby is stable, emergent endoscopy is not indicated. The hemoglobin is normal, so transfusion is also not indicated. Meckel’s diverticulum presents with painless rectal bleeding, and volvulus presents with bilious vomiting.
December 11, 2018 at 9:40 pm
You can also examine mom to see if she has bleeding. I’ve even had 2 cases of discovering bleeding once mom’s starts to pump and we discover bleeding that is occurring internally within her.
December 12, 2018 at 6:32 am
So true! I remember myself when I was pumping and it looked like strawberry milk…