POLYCYTHEMIA
Definition:Venous PCV more than 65%(capillary PCV is 15% higher than venous PCV).or Hb
>22gm/dl
Causes of polycythemia 1
1-increased intrauterine erythropoiesis 
e.g,IUGR,post term, maternal PET,maternal drugs(propranalol), 
maternal smocking,DM,maternal heart disease.Trisomy 13,18,21,beckwith 
Weidman syndrome.
2-Secodary to RBC transfusion:delayed cord clamping(more than 3 minutes) When 
cord clamping is delayed more than 3 minutes after birth, blood volume increases
30%.
,materno-fetal transfusion,twin to twin transfusion. 
3-Increased capillary permeability and plasma loss:cold stress,hypoxia,preterm 
babies,hypovolemia and dehydration
Position after delivery 
pulmonary vascular 
resistance exceeds systemic vascular resistance when Hct >70%. 
Decisions regarding treatment of 
polycythemia should be made on the basis of venous Hct. 
Clinical features
1Symptoms in polycythemia are related
to increased blood viscosity and decreased
blood flow to various organs.
Commonly plethoric but asymptomatic.

Symptoms:lethargy,hypotonia,irritability, 
Poor 
feeding,hypoglycemia,vomiting,acidosis, 
convulsions,NEC,peripheral 
gangrene,renal vein thrombosis. 
TREATMENT 1
Controversal, Decisions regarding treatment of 
polycythemia should be made on the basis of venous Hct. 
If PCV is 65% and no symptoms observe 
If PCV is 65%+symptoms do partial exchange transfusion. 
Exchange with normal saline If venous PCV is 70% and more, aiming a PCV of less 
than 55%.Plasma now is not used
Volume of exchange(mls)=blood volume x Wt x (observed-desired PCV ) /observed 
PCV
Blood volume in term infants=80-90 ml/kg and in preterm=90-100ml/kg 