Perinatal polycythemia and hyperviscosity syndrome

[Tina]

Polycythemia is an abnormal increase in red blood cell mass, defined in neonates as a venous hematocrit ≥ 65%; this increase can lead to hyperviscosity with sludging of blood within vessels and sometimes thrombosis. The main symptoms and signs of neonatal polycythemia are nonspecific and include ruddy complexion, feeding difficulties, lethargy, hypoglycemia, hyperbilirubinemia, cyanosis, respiratory distress, and seizures. Diagnosis is made clinically and with an arterial or venous hematocrit measurement. Treatment is with partial exchange transfusion.
(Prenatal and perinatal changes in erythropoiesis are discussed in Perinatal Physiology.)
The terms polycythemia and hyperviscosity are often used interchangeably but are not equivalent. Polycythemia is significant only because it increases risk of hyperviscosity syndrome. Hyperviscosity is a clinical syndrome caused by sludging of blood within vessels. Sludging occurs because increased red blood cell mass causes a relative decrease in plasma volume and a relative increase in proteins and platelets.
Incidence of polycythemia is about 3 to 4% (range 0.4 to 12%), and about half of infants with polycythemia have hyperviscosity.