Neonatal polycythemia: II. Plasma, blood and red cell volume estimates in relation to hematocrit levels and quality of intrauterine growth.
Neonatal polycythemia: II. Plasma, blood and red cell volume estimates in relation to hematocrit levels and quality of intrauterine growth.
复制标题
新生儿红细胞增多症：II．
作者：
Y. Brans;D. L. Shannon;R. Ramamurthy
在出生后 32 小时内，对 39 名正常生长的新生儿、14 名宫内生长迟缓的新生儿和 20 名巨大儿的新生儿的血浆 (PV)、血液 (BV) 和红细胞 (RCV) 体积进行了估计。总PV、BV和RCV随出生体重线性增加，并且不受胎儿生长质量偏差的影响。就体重而言，PV/kg、BV/kg 和 RCV/kg 与出生体重和宫内生长质量均不相关。脐静脉血细胞比容 (UV Hct) 水平为 51% 至 60%、61% 至 65% 和 66% 至 77% 的新生儿的平均 PV/kg 逐渐降低，但无统计学差异（分别为 38.1 +/- 4.49、37.6 +/- 5.41 和 34.8 +/- 5.16 ml/kg）。另一方面，他们的平均 BV/kg 逐渐升高（90 +/- 10.1 与 101 +/- 13.7 ml/kg，P 小于 0.002，以及 110 +/- 19.0 ml/kg，P 小于 0.001）。他们的平均 RCV/kg 也逐渐升高（52 +/- 7.4、64 +/- 8.7 和 75 +/- 16.4 ml/kg，P 小于 0.001）。尽管 PV/kg 与 UV Hct 不相关，但 BV/kg 和 RCV/kg 都随着 UV Hct 的增加而线性增加（分别为 r = 0.58 和 r = 0.79）。对 29 名新生儿进行部分换血后重复进行容量估计。平均 UV Hct 从交换前的 63 +/- 5.9% 下降至交换后的 51 +/- 5.2%（P 小于 0.001），平均 PV 从 37.7 +/- 5.56 增加至 47.6 +/- 7.99 ml/kg（P 小于 0.001），平均 RCV 从 67 +/- 16.5 下降至 51 +/- 12.3 ml/kg （P 小于 0.001）。尽管采取了预防措施来保持部分交换等容，但平均 BV 从 105 +/- 18.7 下降到 98 +/- 18.0 ml/kg (P = .001)，并且平均 PV 增加 (10 ml/kg) 小于平均 RCV 减少 (16 ml/kg)。这些数据表明，红细胞增多症新生儿的 PV 正常，但其 RCV 和 BV 升高，与 UV Hct 成正比。 “等容”部分换血可降低 UV Hct、RCV 和 BV，并增加 PV。
Volumes of plasma (PV), blood (BV), and red cells (RCV) were estimated within 32 hours of birth in 39 neonates with normal growth, 14 neonates with intrauterine growth retardation, and 20 neonates with macrosomia. Total PV, BV, and RCV increased linearly with birth weight and were unaffected by deviation in the quality of fetal growth. In proportion to body weight, PV/kg, BV/kg, and RCV/kg correlated neither with birth weight nor with the quality of intrauterine growth. Neonates with umbilical vein hematocrit (UV Hct) levels 51% to 60%, 61% to 65%, and 66% to 77% had progressively lower, but not statistically different, mean PV/kg (38.1 +/- 4.49, 37.6 +/- 5.41, and 34.8 +/- 5.16 ml/kg, respectively). On the other hand, they had progressively higher mean BV/kg (90 +/- 10.1 vs 101 +/- 13.7 ml/kg, P less than .002, and vs 110 +/- 19.0 ml/kg, P less than .001). They also had progressively higher mean RCV/kg (52 +/- 7.4, 64 +/- 8.7, and 75 +/- 16.4 ml/kg, P less than .001). Although PV/kg did not correlate with UV Hct, both BV/kg and RCV/kg increased linearly with increasing UV Hct (r = .58 and r = .79, respectively). Volume estimates were repeated after partial exchange transfusion in 29 neonates. Mean UV Hct decreased from 63 +/- 5.9% preexchange to 51 +/- 5.2% postexchange (P less than .001), mean PV increased from 37.7 +/- 5.56 to 47.6 +/- 7.99 ml/kg (P less than .001) and mean RCV decreased from 67 +/- 16.5 to 51 +/- 12.3 ml/kg (P less than .001). Despite precautions to keep the partial exchange isovolemic, mean BV decreased from 105 +/- 18.7 to 98 +/- 18.0 ml/kg (P = .001) and the mean PV increase (10 ml/kg) was less than the mean RCV decrease (16 ml/kg). These data suggest that neonates with polycythemic have normal PV but their RCV and BV are elevated in direct proportion to UV Hct. "Isovolemic" partial exchange transfusion decreases UV Hct, RCV, and BV and increases PV.