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Question :

Posted On : 17 Mar 2007

A neonate on day 3 presents with dullness. On examination vitals are stable, crying, sucking,activity and neonatal reflexes are not satisfactory. IV antibiotics , iv fluids are started and CBC, CRP done. Vitamin K is also given. Hb is 10.3g,dl, TLC is 2 lacs,mm3 with normal platelets. 40 Percentnormoblasts are seen and there are no atypical WBCs seen.{Blood reports checked thrice by different laboratories}.The baby showed improvement initially but on day 5 had massive hematemesis and the child was in impending hemorrhagic shock which was managed by FFPs and packed red cells. What is the further line of investigations and management and what is the differential diagnosis?

Expert Answer :

No expert answer available.

Answer Discussion :

Anay Deshmukh

Investigations:- Peripheral smear, Retic.count,d-Dimer assay.

18 years ago

Dragana Stamatovic

Dg: Newborn haemorhagical disease
Dif dg : Neonatal sepsis

18 years ago

Dr Sanjay

Leukamoid reaction and juvenile CML should be considered as differential diagnosis since there are no atypical cells seen and platelets are normal. Blood Leucocyte Alkaline Phosphate should be ascertained. Also such a condition warrants a bone marrow examination for evaluation. Trisomy 21 should be ruled out by karyotyping since these babies could be phenotypically normal.
If the counts remain high and baby is symptomatic then an exchange transfusion should be tried to decrease hyperviscosity symptoms.

18 years ago

Dr Sanjay

this seems like a leukamoid reaction however juvenile CML should also be considered. blood LAP should be ascertained. Bone marrow examination should be done. Since trisomy 21 can aslo lead to TMD, a karyotyping should be ordered since these babies can be phenotypically normal.
If the counts remain high and baby symptomatic exchange transfusion should be considered.

18 years ago

Wong Ann Cheng

congenital herpes infection

18 years ago

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