A neonate born at term to an Rh-sensitized mother has cord blood hemoglobin of 10.5 g/dL and cord bilirubin of 6 mg/dL. The baby is pale and the liver and spleen are palpable 4 cm below the costal margin. What does this combination indicate?
- A Mild hemolysis manageable with phototherapy alone
- B Physiological hyperbilirubinemia of the newborn
- C Severe hemolytic disease for which exchange transfusion should be considered at birth ✓
- D Congenital hypothyroidism with indirect hyperbilirubinemia
Correct answer: C. Severe hemolytic disease for which exchange transfusion should be considered at birth
Explanation
In hemolytic disease of the fetus and newborn, a cord hemoglobin below 12 g/dL and a cord bilirubin above 5 mg/dL signify significant hemolysis, and hepatosplenomegaly with pallor confirms moderate to severe disease. Such babies are candidates for exchange transfusion at birth because phototherapy alone cannot keep pace with ongoing hemolysis and risks kernicterus. Physiological jaundice never appears in cord blood, since cord bilirubin above 2 mg/dL is always pathological.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.