Neonatal Hemolytic Jaundice: Morphologic Features of Erythrocytes That Will Help You Diagnose the Underlying Condition

Background: Many cases of severe neonatal hyperbilirubinemia never have the underlying cause of the jaundice clearly identified. Thus they are said to have ‘idiopathic’ severe neonatal jaundice. However, finding the exact cause, if it is a genetic condition, can enable informed anticipatory guidance regarding future episodes of hemolysis, anemia, or bilirubin cholelithiasis. Objective: ‘Next generation’ gene sequencing can often reveal the mutations responsible for severe neonatal hyperbilirubinemia, but wisely using this new technology involves selective application, employing this testing only if inexpensive technology fails to reveal the diagnosis. Methods: In this review, we display and discuss five types of red blood cell morphological abnormalities that have helped us categorize cases of neonatal hemolytic jaundice. Results: As an aid to applying inexpensive technology, we review morphological abnormalities of erythrocytes that are easily identified on a blood film. When found, these abnormalities can be important clues to the underlying hemolytic condition giving rise to neonatal jaundice. Conclusions: Applying these simple and inexpensive methods can assist neonatologists in caring for neonates who have hemolytic Received: October 7, 2013 Accepted after revision: November 13, 2013 Published online: February 8, 2014 Dr. Robert D. Christensen Women and Newborn’s Clinical Program Intermountain Healthcare 4401 Harrison Blvd, Ogden, UT 84403 (USA) E-Mail rdchris4 @ ihc.com © 2014 S. Karger AG, Basel 1661–7800/14/1054–0243$39.50/0