Hematology & Hyperbilirubinemia Flashcards
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Which condition is one of the most common causes of neonatal thrombocytopenia in the NICU?
Answer: Neonatal alloimmune thrombocytopenia (NAIT) or maternal immune thrombocytopenia (ITP)
NAIT occurs when maternal antibodies target fetal platelet antigens (commonly HPA-1a), and ITP transfers maternal anti-platelet IgG antibodies to the fetus, both causing significant neonatal thrombocytopenia.
What is the primary clinical purpose of measuring the reticulocyte count in a neonate with suspected anemia?
Answer: To assess bone marrow response and differentiate hemolytic from hypoproliferative anemia
An elevated reticulocyte count indicates the bone marrow is responding to increased red blood cell destruction (hemolysis), while a low count suggests inadequate production (hypoproliferative anemia).
A neonate receiving phototherapy develops a gray-brown discoloration of the skin, urine, and serum. Which condition does this indicate?
Answer: Bronze baby syndrome associated with elevated conjugated bilirubin
Bronze baby syndrome occurs when neonates with elevated direct (conjugated) bilirubin receive phototherapy; the resulting photoproducts cannot be excreted and accumulate, causing discoloration.
Which blood product is preferred for exchange transfusion in a neonate with Rh hemolytic disease of the newborn?
Answer: O-negative, irradiated, CMV-negative PRBCs reconstituted with AB-positive plasma
O-negative irradiated CMV-negative PRBCs are used to avoid further hemolysis from Rh antibodies, prevent CMV infection, and avoid transfusion-associated graft-versus-host disease in the immunocompromised neonate.
Which maternal condition most commonly causes neonatal polycythemia through the mechanism of chronic fetal hypoxia?
Answer: Maternal hypertension with placental insufficiency
Placental insufficiency from maternal hypertension reduces fetal oxygen delivery, stimulating erythropoietin production and compensatory erythrocytosis, resulting in neonatal polycythemia.
During a PRBC transfusion, a neonate develops a temperature of 38.3°C and urticarial rash. Which is the nurse's priority action?
Answer: Stop the transfusion immediately and notify the provider
Fever with urticaria during transfusion are signs of a transfusion reaction; the nurse must immediately stop the transfusion, maintain IV access with normal saline, and notify the provider to evaluate and manage the reaction.
Which finding most reliably indicates that intensive phototherapy is effective in a neonate with hyperbilirubinemia?
Answer: Decrease in total serum bilirubin of at least 1-2 mg/dL within the first 4-6 hours of therapy
Intensive phototherapy is considered effective when TSB decreases by approximately 1-2 mg/dL within the first 4-6 hours, reflecting successful photoisomerization of bilirubin to excretable isomers.