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Anemia and Increased Bleeding Time
The Relationship between Hematocrit and Bleeding Time in Very Low Birth Weight Infants during the First Week of Life. Sola MC, del Vecchio A, Edwards TJ, et al. J Perinatol 2001 (Sep); 21: 368 – 371.
This study was done to determine if anemia caused a prolongation of bleeding time in VLBW infants during the first week of life, as it does in adults. Template bleeding times were performed in 20 VLBW infants < 7 days old, before and again following a clinically ordered erythrocyte transfusion. Neonates who had pre-transfusion hematocrits < 28 had longer bleeding times, which fell 164 +/- 25 seconds (p < 0.0001) following transfusion. Patients with pre-transfusion hematocrits > 28 had no significant reduction in bleeding time following transfusion.
Comments. We need to be careful that in our zeal to limit blood exposure in VLBW premature babies, that we do not increase their risk of serious bleeding problems, especially intraventricular hemorrhage (IVH). It is not known whether a 2 ½ minute prolongation of bleeding time as a result of anemia, is actually associated with an increased risk of IVH. It certainly seems that if might be. Until better data about this risk is available, we would be wise to maintain hematocrits > 28 – 30 in VLBW babies during the first week of life (when the risk of IVH is greatest). Incidentally, this seems like a good time to remind ourselves about an often-overlooked method to avoid excessive blood transfusions during the first week of life for VLBW infants. I’m talking about delayed clamping of the umbilical cord at delivery. Refer to 1-024 for a review of study by Ibraham et al on this topic.