Yenidoğan Döneminde Anemiler, Trombositopeniler ve Koagülasyon Bozuklukları
Özet
Neonatal dönem, hematopoetik ve hemostatik sistemlerin fizyolojik immatüritesi nedeniyle çeşitli hematolojik hastalıkların sık görüldüğü özel bir dönemdir. Özellikle prematüre yenidoğanlarda anemi, trombositopeni ve koagülasyon bozuklukları önemli morbidite ve mortalite nedenleri arasında yer almaktadır. Yenidoğanlarda hematolojik parametrelerin değerlendirilmesi sırasında gestasyon haftası, postnatal yaş ve neonatal döneme özgü fizyolojik özellikler mutlaka dikkate alınmalıdır. Neonatal anemiler; kan kaybı, artmış eritrosit yıkımı veya yetersiz eritrosit üretimi sonucunda gelişebilir. Hemolitik hastalıklar, prematüre anemisi, fetomaternal hemoraji, konjenital enfeksiyonlar ve kalıtsal eritrosit hastalıkları neonatal dönemin önemli anemi nedenlerini oluşturmaktadır. Neonatal trombositopeni ise özellikle yenidoğan yoğun bakım ünitelerinde sık karşılaşılan hematolojik sorunlardan biridir. Etiyolojide plasental yetmezlik, neonatal sepsis, immün trombositopeniler ve kalıtsal trombosit hastalıkları yer almaktadır. Özellikle neonatal alloimmün trombositopeni, sağlıklı term yenidoğanlarda ağır trombositopeni ve intrakraniyal kanama açısından önemli bir klinik tablo oluşturmaktadır. Yenidoğan dönemindeki koagülopatiler arasında vitamin K eksikliği kanamaları, dissemine intravasküler koagülasyon, herediter faktör eksiklikleri ve karaciğer hastalıklarına bağlı koagülasyon bozuklukları önemli yer tutmaktadır. Bu bölümde yenidoğan döneminde görülen anemiler, trombositopeniler ve koagülasyon bozuklukları; fizyopatoloji, klinik özellikler, tanısal yaklaşım ve güncel tedavi yöntemleri açısından ele alınmıştır.
The neonatal period represents a unique stage in which hematologic disorders are frequently encountered because of the physiological immaturity of the hematopoietic and hemostatic systems. Anemia, thrombocytopenia, and coagulation disorders are among the major causes of morbidity and mortality, particularly in preterm infants. Interpretation of hematologic parameters in newborns requires consideration of gestational age, postnatal age, and the physiological characteristics specific to neonatal life. Neonatal anemia may develop as a result of blood loss, increased erythrocyte destruction, or impaired erythrocyte production. Hemolytic diseases, anemia of prematurity, fetomaternal hemorrhage, congenital infections, and inherited red blood cell disorders are among the major causes of neonatal anemia. Neonatal thrombocytopenia is also one of the most common hematologic abnormalities encountered in neonatal intensive care units. Its etiology includes placental insufficiency, neonatal sepsis, immune-mediated thrombocytopenia, and inherited platelet disorders. In particular, neonatal alloimmune thrombocytopenia is an important cause of severe thrombocytopenia and intracranial hemorrhage in otherwise healthy term neonates. Coagulation disorders in the neonatal period include vitamin K deficiency bleeding, disseminated intravascular coagulation, inherited coagulation factor deficiencies, and liver disease–associated coagulopathies. This chapter reviews neonatal anemia, thrombocytopenia, and coagulation disorders with emphasis on their pathophysiology, clinical manifestations, diagnostic evaluation, and current treatment approaches.
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