What is the management approach for a newborn with target cells positive on their blood smear?

From the Guidelines

The management approach for a newborn with target cells positive on their blood smear should begin with a comprehensive diagnostic workup to identify the underlying cause, as target cells can indicate various conditions including hemoglobinopathies, liver disease, or post-splenectomy states. Initial steps include confirming the finding with a complete blood count and peripheral smear review by a hematologist.

• Hemoglobin electrophoresis should be performed to evaluate for hemoglobinopathies such as sickle cell disease or thalassemia, as recommended by the American Academy of Pediatrics 1.
• Liver function tests are also important to rule out hepatic causes. If hemoglobinopathy is confirmed, the newborn should be referred to a pediatric hematologist for specialized care.
• For sickle cell disease, prophylactic penicillin (penicillin V potassium 125 mg orally twice daily) should be initiated by 2 months of age to prevent pneumococcal infections, as suggested by studies on newborn screening and management of sickle cell disease 1. Immunizations should be administered according to schedule, with special attention to pneumococcal and meningococcal vaccines.
• Parents should be educated about signs of complications requiring immediate medical attention, such as fever, pallor, lethargy, or respiratory distress. Genetic counseling should be offered to the family.
• Regular follow-up is essential, typically every 2-3 months during the first year of life, to monitor growth, development, and disease progression, as emphasized in guidelines for health supervision of children with sickle cell disease 1. Target cells themselves don't require specific treatment, but addressing the underlying condition is crucial for proper management.

From the Research

Management Approach for Newborn with Target Cells Positive

• The presence of target cells in a newborn's blood smear can be an indication of a hemoglobinopathy, such as sickle cell disease or other abnormal hemoglobin variants 2, 3.
• Newborn screening for hemoglobinopathies is typically performed using methods such as isoelectric focusing or high-performance liquid chromatography (HPLC) 4, 5.
• If a newborn screens positive for a hemoglobinopathy, confirmatory testing is necessary to determine the specific diagnosis and to differentiate between different types of hemoglobin variants 6.
• Management of a newborn with a confirmed hemoglobinopathy diagnosis may involve regular monitoring of hemoglobin levels, reticulocyte counts, and other laboratory parameters, as well as preventive measures such as vaccination against pneumococcal disease and other infections 2, 3.

Diagnostic Considerations

• The diagnosis of hemoglobinopathies in newborns can be challenging due to the presence of fetal hemoglobin, which can mask the presence of abnormal hemoglobin variants 4, 5.
• Premature infants may be more likely to have false positive results on newborn screening tests for hemoglobinopathies 6.
• The use of capillary electrophoresis technology, such as the Capillarys Neonat Fast Hb device, can help to improve the accuracy of newborn screening for hemoglobinopathies 4.

Clinical Implications

• Newborns with hemoglobinopathies, such as sickle cell disease, are at risk for significant clinical complications, including anemia, infections, and other sickling events 2, 3.
• Early diagnosis and management of hemoglobinopathies can help to reduce the risk of these complications and improve outcomes for affected newborns 2, 3.