NECROTIZING ENTEROCOLITIS CAN BE CAUSED BY POLYCYTHEMIA IN THE NEWBORN DOG

Abstract

Although necrotizing enterocolitis (NEC) has been associated with polycythemia in human infants, they have not been shown to be causally related. To elicit a possible causal relationship the following experiment was performed. 46 unanesthetized puppies were studied (age 6-14d). Normovolemic polycythemia Hct 70, was induced in 19 pups by exchange transfusion with 75cc/kg of red blood cells (RBC). Hypervolemic polycythemia, Hct 70, was induced in 14 pups by transfusion with 50cc/kg of RBC. 13 pups received exchange transfusion with whole blood and served as controls, Hct 40. Gross autopsy was performed on all pups at 24 hrs post-transfusion or at death. NEC was defined as areas of violaceous discoloration of the bowel associated with blood in the intestinal lumen. Although lesions appeared throughout the bowel in some pups, involvement of the distal small bowel was most common. Diagnosis was confirmed by microscopic examination. Microscopic changes ranged from mucosal hemorrhage and necrosis to transmural necrosis, hemorrhage and inflammation. Submucosal pneumatosis intestinalis was seen in two cases and air was discerned in ileocecal lymph nodes in one case. Both gross and microscopic lesions appear similar to that in NEC in human infants. NEC was seen in 11/19 pups with normovolemic polycythemia, 7/14 pups with hypervolemic polycythemia, and only 1/13 controls (p<.01). Necrotizing enterocolitis can be caused by polycythemia in the newborn dog.

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