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A 6 week old ex-30 4/7 weeks twin A male infant was seen at an outside clinic because his parents felt that his heart was beating faster than his twin sibling’s and was found to have a hemoglobin of 7.9 g/dL. The clinic referred him in to the ED for blood transfusion and hematology consultation. The heart rate is 165 bpm on the monitor, blood pressure is 74/40, cap refill is < 2 seconds, and color is pink. The remainder of his CBC is normal, and the patient is afebrile, feeding and growing well, and asymptomatic except for his heart rate. Reticulocyte count is 4.77%.
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November 7, 2017 at 10:33 am
E) Discharge the patient home with iron supplementation and close follow-up with a pediatrician. As infants transition from fetal circulation to post-natal circulation, they typically experience an RBC nadir due to increased availability of oxygen and downregulation of erythropoietin. The nadir low point is usually a hemoglobin of 9-11 g/dL, occurring at 8-12 weeks of life. Premature infants can have an even lower nadir due to poor iron stores, blood draws associated with NICU care, and blunted erythropoietin response. Their nadir is usually 7-9 g/dL, occurring earlier at 3-6 weeks of life. This expected anemia can be managed with iron supplementation and observation in the otherwise asymptomatic infant. SVT typically presents with a heart rate > 220 bpm in this age group, so adenosine would not be indicated. A quick reference of common pediatric lab normals that differ from adult normals can be found on the algorithms page at http://pemsource.org/algorithms/ under “Peds Labs”