Neonatal Polisitemi
Özet
Yenidoğan polisitemisi, periferik venöz hematokrit düzeyinin %65 ve üzerinde veya hemoglobin konsantrasyonunun 22 g/dL'den fazla olmasıyla tanımlanan, artmış eritrosit kitlesi durumudur. Görülme sıklığı tüm canlı doğumların %1,5-5'i arasında değişen bu tablo, temelde intrauterin eritropoezin artması veya fetal eritrosit hipertransfüzyonu mekanizmalarıyla ortaya çıkar. Kanın Newtoncu olmayan yapısı nedeniyle, polisitemi sonucu gelişen hiperviskozite kan akımına karşı direnci artırarak organ disfonksiyonuna, mikro-dolaşımda trombüs oluşumuna ve doku oksijenizasyonunun bozulmasına yol açar. Etiyolojisinde intrauterin hipoksi, maternal diyabet, plasental yetmezlik ve kordonun geç klemplenmesi gibi faktörler öne çıkmaktadır. Vakaların yarısından fazlası asemptomatik seyretse de; solunum sıkıntısı, beslenme güçlüğü, hipoglisemi, hipotoni ve hiperbilirubinemi gibi ciddi klinik bulgular görülebilir. Tedavi yaklaşımı hastanın semptom durumuna ve hematokrit düzeyine göre belirlenir; hafif vakalarda hidrasyon desteğiyle konservatif izlem tercih edilirken, ciddi semptomatik vakalarda veya çok yüksek hematokrit değerlerinde en etkili yöntem damar içi hacmi koruyarak vizkoziteyi azaltan parsiyel exchange transfüzyondur.
Neonatal polycythemia is defined as a peripheral venous hematocrit level of 65% or higher or a hemoglobin concentration exceeding 22 g/dL, representing an increased erythrocyte mass. The incidence of this condition varies between 1.5% and 5% of all live births and primarily occurs through mechanisms of increased intrauterine erythropoiesis or fetal erythrocyte hypertransfusion. Due to the non-Newtonian nature of blood, hyperviscosity resulting from polycythemia increases resistance to blood flow, leading to organ dysfunction, thrombus formation in microcirculation, and impaired tissue oxygenation. Factors such as intrauterine hypoxia, maternal diabetes, placental insufficiency, and delayed cord clamping stand out in its etiology. Although more than half of the cases are asymptomatic, serious clinical findings such as respiratory distress, feeding difficulties, hypoglycemia, hypotonia, and hyperbilirubinemia can be observed. The treatment approach is determined by the patient's symptomatic status and hematocrit level; while conservative monitoring with hydration support is preferred in mild cases, partial exchange transfusion, which reduces viscosity while maintaining intravascular volume, is the most effective method for severe symptomatic cases or very high hematocrit values.
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