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Hematology & Hyperbilirubinemia Flashcards

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  1. A term neonate at 36 hours of life has a total serum bilirubin (TSB) of 13 mg/dL, placing it in the high-intermediate risk zone on the Bhutani nomogram. Which intervention is most appropriate?

    Answer: Repeat TSB in 4-6 hours and monitor the trajectory closely

    In the high-intermediate risk zone, close monitoring with repeat TSB in 4-6 hours is appropriate to assess the rate of rise before escalating to phototherapy.

  2. Which form of bilirubin is considered neurotoxic in the neonate because it can cross the blood-brain barrier?

    Answer: Unconjugated (indirect) bilirubin

    Unconjugated bilirubin is lipid-soluble and can cross the blood-brain barrier, depositing in the basal ganglia and causing bilirubin encephalopathy.

  3. A 3-day-old neonate exhibits lethargy, hypotonia, a high-pitched cry, and opisthotonus (arching). These findings are most consistent with which complication of severe hyperbilirubinemia?

    Answer: Acute bilirubin encephalopathy (kernicterus)

    Acute bilirubin encephalopathy presents with these classic neurological signs caused by unconjugated bilirubin depositing in the basal ganglia and brainstem.

  4. A positive direct antiglobulin test (DAT/direct Coombs test) in a neonate most strongly suggests which condition?

    Answer: ABO incompatibility or Rh hemolytic disease of the newborn

    A positive DAT indicates maternal IgG antibodies are coating the neonate's red blood cells, which is characteristic of ABO or Rh isoimmunization causing hemolytic disease.

  5. Physiologic jaundice in a healthy term neonate typically becomes visible on which day of life?

    Answer: Days 2-3

    Physiologic jaundice appears on days 2-3 as bilirubin accumulates from normal red blood cell turnover; jaundice visible within the first 24 hours is always considered pathologic.

  6. Which laboratory value defines polycythemia in the neonate?

    Answer: Central venous hematocrit of 65% or greater

    Neonatal polycythemia is defined as a central venous hematocrit of 65% or higher, which significantly increases blood viscosity and can impair organ perfusion.

  7. A 28-week preterm neonate on day 21 of life has a hemoglobin of 7 g/dL with associated tachycardia and poor weight gain. Which intervention is most appropriate?

    Answer: Packed red blood cell (PRBC) transfusion

    Symptomatic anemia of prematurity with hemoglobin at or below 7-8 g/dL accompanied by clinical signs of hemodynamic compromise is a standard indication for PRBC transfusion.