Physiological hyperbilirubinaemia in the newborn and the reservoir function of the spleen

Abstract

Weech has compared the onset of pulmonary respiration with the igniting spark which initiates the explosion-like destruction of erythrocytes and haemoglobin in the newborn, which is one of the chief causes, the other being hepatic immaturity, of physiological hyperbilirubinaemia. If an attempt is made to say exactly how the ignition takes place, and where the destruction occurs, the answer appears to be as follows. The onset of pulmonary respiration abolishes intrauterine hypoxaemia. The calls on the means of oxygen transport - the erythrocytes and the haemoglobin - are fewer than before. An unusually large number of red blood corpuscles therefore accumulate in the blood reservoirs of the spleen. This reveals itself in the swelling of the spleen which is characteristic of the newborn period, culminating on about the third day of life. An increased destruction of erythrocytes and haemoglobin begins, owing to the intimate connexion between the reservoir and the haemolytic functions of the spleen, and this in its turn leads to an increase in the bilirubin content of the blood.