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Discussion

Defining a term: plethora?

Hi everyone, I'm in peds/ob right now and just spent a day in the nursery. I have to fill out a w/s and it listed terms and then asked for the description and location. For instance: acrocyanosis, lanugo, mongolian spots, etc.

So, my question is what is plethora in relation to a newborn and where is it located?

I found this as the definition "a bodily condition characterized by an excess of blood and marked by turgescence and a florid complexion." Is it generalized? Also, curious as to what the patho is behind this and who is more proned to it.

Thanks!

Featured Replies

High-Risk Newborn

Polycythemia

What is polycythemia?

Polycythemia is a condition in which there are too many red blood cells in the blood circulation. It is the opposite of anemia, which results from too few red blood cells in the blood circulation. Polycythemia is also called plethora.

What causes polycythemia?

Polycythemia may be caused by the following:

  • increased red blood cell production:

    • A fetus with chronically lowered oxygen levels responds by producing extra red blood cells.
    • Some chromosomal abnormalities may cause increased red blood cell production.

  • extra blood cells enter the baby's circulation from another source:

    • A delay in clamping the umbilical cord after delivery results in blood from the placenta entering the baby's circulation.

    • Twin-to-twin transfusion, when the shared placenta of the two babies has a connecting circulation and blood flows from one baby to the other, may result in polycythemia.

Who is affected by polycythemia?

Polycythemia may occur with many different conditions. Some of the babies affected by polycythemia include:

  • those born at high altitudes because of the greater demand for blood to carry oxygen.
  • those born after 42 weeks gestation.

  • small for gestational age (SGA) / intrauterine growth restriction (IUGR).
  • identical twins who share a placenta and develop twin-to-twin transfusion.

  • infants of diabetic mothers.
  • those with chromosomal abnormalities including trisomies 13, 18, and 21 (Down syndrome).

Why is polycythemia a concern?

Mild polycythemia may not cause problems. However, too many red blood cells can increase the blood volume or thicken the blood, making it harder to circulate through the blood system and to the organs. Babies can have difficulty breathing and their heart and blood vessels cannot compensate for the extra amount of blood. As the large numbers of cells begin to break down, a substance called bilirubin is produced. Increased bilirubin levels, called hyperbilirubinemia, can cause jaundice, a yellowing of the skin, eyes, and mucous membranes. Seizures can also occur with polycythemia.

What are the symptoms of polycythemia?

Many babies with polycythemia have no visible symptoms of the condition. The following are the most common symptoms of polycythemia. However, each baby may experience symptoms differently. Symptoms may include:

  • deep reddish-purple coloring
  • poor feeding
  • lethargy
  • rapid breathing or respiratory distress
  • jaundice (yellowing of the skin, eyes, and mucous membranes)
  • low blood sugar

The symptoms of polycythemia may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

How is polycythemia diagnosed?

Laboratory tests show a high hematocrit (red blood cell count) when polycythemia is present. A high hemoglobin (protein in the blood that carries oxygen) level may also help diagnose polycythemia.

Treatment for polycythemia:

Specific treatment for polycythemia will be determined by your baby's physician based on:

  • your baby's gestational age, overall health, and medical history
  • extent of the disease
  • your baby's tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include:

  • removing some of the blood volume, thus, reducing the number of the red blood cells.
  • replacement of the withdrawn blood with fluids (to help dilute the red blood cell concentration).

  • partial exchange transfusion (slowly removing and replacing a large portion of the baby's blood volume).

These treatments are performed through a vein or artery, often the umbilical blood vessels.

http://www.healthsystem.virginia.edu/uvahealth/peds_hrnewborn/polycyth.cfm

A plethora?

Disclaimer: This is just silly and not helpful at all. Sorry, I just had to add it.

  • Experts

plethora as defined by taber's is "overfullness of blood vessels or of the total quantity of any fluid in the body." it is a symptom. . .often of perinatal polycythemia and hyperviscosity syndrome or of superior vena cava syndrome. the pathophysiology lies with the disease process that is going on which you must identify since plethora is merely a symptom of the underlying disease process.

from page 182 of differential diagnosis in primary care, 4th edition, by r. douglas collins. . ."flushed face (plethora). . .the causes of this symptom...a flushed face may result from an increased amount of circulating blood (polycythemia)or from any factor that may dilate the blood vessels in the face.

polycythemia may be primary, as in polycythemia vera, or secondary, as in cushing syndrome, unilateral renal disease, hypernephroma, and pulmonary or cardiovascular disease associated with chronic anoxia. capillary dilatation may result from serotonin output in carcinoid syndrome, from vasomotor instability of menopause, from chronic alcoholism (which causes direct capillary dilatation), from sunburn or any burn that damages the capillaries and precapillary arterioles so that they cannot contract, and from mitral stenosis, where the back pressure from the heart causes congestion of the capillaries. it is less commonly found in the use of belladonna, alkaloids, histamine headaches (usually unilateral), and cirrhosis of the liver, but it is common in chronic skin diseases of the face such as acne rosacea.

approach to the diagnosis. . .the clinical picture will often point to the diagnosis. for example, a flushed face with obesity would suggest cushing syndrome. a flushed face with a heart murmur would suggest mitral stenosis or a right to left shunt with polycythemia. a flushed face with wheezing would suggest pulmonary emphysema. a flushed face and chronic diarrhea would prompt one to consider a carcinoid syndrome."

  • Author

Chrissy & Daytonite: Thanks so much for the help, very helpful information. Makes sense now.

NewCareerForMe: Ha, that's great! I'm not the only who didn't know!

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