Erythropoietin increases reticulocyte counts and maintains hematocrit in neonates requiring surgery

Bierer, Ryann; Roohi, Mahshid; Peceny, Connie; Ohls, Robin K.

doi:10.1016/j.jpedsurg.2008.10.112

Cited by 20 publications

(6 citation statements)

References 29 publications

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“…Although we did not measure peak Epo concentrations in these infants, based on our previous study evaluating Epo concentrations in preterm infants receiving 400 units/kg three times a week SC (45), peak Epo concentrations in preterm infants receiving once weekly dosing would be in the range of 4,000 to 6,000 mU/mL. This range might be high enough to provide neuroprotection in preterm infants (46).…”

Section: Discussionmentioning

confidence: 99%

A Randomized, Masked Study of Weekly Erythropoietin Dosing in Preterm Infants

Ohls

Roohi

Peceny

et al. 2012

The Journal of Pediatrics

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Background Erythropoietin (Epo) increases and maintains hematocrit using once weekly dosing in adults with anemia due to end stage renal disease. Epo is used in preterm infants to treat the anemia of prematurity, but has not been studied using once weekly dosing, a schedule which might offer neuroprotection in addition to increasing red cell mass. We compared reticulocyte responses of once weekly Epo dosing with thrice weekly dosing in preterm infants. Methods Infants ≤1,500 grams and ≥7 days of age were randomized to once weekly Epo, 1,200 units/kg/dose, or thrice weekly Epo, 400 units/kg/dose, subcutaneously for 4 weeks, along with iron and vitamin supplementation. Complete blood counts, absolute reticulocyte counts (ARC), transfusions, phlebotomy losses, and adverse events were recorded. Results Twenty preterm infants (962±55 grams, 27.9±0.4 weeks, 17±3 days of age) were enrolled. Groups were similar at baseline. Infants in both groups increased ARC (p<0.01, thrice weekly Epo group). ARC were similar between treatment groups at the start and end of 4 weeks. Hematocrit remained stable, and similar numbers of transfusions were administered. No adverse effects of either dosing schedule were noted. Conclusions Preterm infants respond to weekly Epo by increasing ARC and maintaining hematocrit. We speculate that once weekly Epo dosing might be beneficial to preterm infants requiring increased erythropoiesis.

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Section: Discussionmentioning

confidence: 99%

A Randomized, Masked Study of Weekly Erythropoietin Dosing in Preterm Infants

Ohls

Roohi

Peceny

et al. 2012

The Journal of Pediatrics

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“…Erythropoietin has been used to increase hematocrit preoperatively either alone or as an adjunct to PAD. In a recent study, neonates undergoing major surgery such as gastroschisis, duodenal atresia or congenital diaphragmatic hernia repair were randomized to receive either erythropoietin or placebo for 14 days (58). A strict transfusion protocol was used.…”

Section: Alternatives To Blood Transfusionsmentioning

confidence: 99%

Blood transfusion risks and alternative strategies in pediatric patients

Lavoie

2010

Pediatric Anesthesia

180

137

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Although the safety of the blood supply has been greatly improved, there still remain both infectious and noninfectious risks to the patient. The incidence of noninfectious transfusion reactions is greater than that of infectious complications. Furthermore, the mortality associated with noninfectious risks is significantly higher. In fact, noninfectious risks account for 87-100% of fatal complications of transfusions. It is concerning to note that the majority of pediatric reports relate to human error such as overtransfusion and lack of knowledge of special requirements in the neonatal age group. The second most frequent category is acute transfusion reactions, majority of which are allergic in nature. It is estimated that the incidence of adverse outcome is 18:100,000 red blood cells issued for children aged less than 18 years and 37:100,000 for infants. The comparable adult incidence is 13:100,000. In order to decrease the risks associated with transfusion of blood products, various blood-conservation strategies can be utilized. Modalities such as acute normovolemic hemodilution, hypervolemic hemodilution, deliberate hypotension, antifibrinolytics, intraoperative blood salvage, and autologous blood donation are discussed and the pediatric literature is reviewed. A discussion of transfusion triggers, and algorithms as well as current research into alternatives to blood transfusions concludes this review.

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“…This hypothesis is supported by multiple publications examining the role of EPO in erythropoiesis. Bierer et al found that erythropoietin reduces Ca 2+ uptake and thereby providing protection from early clearance and hence supporting the ability of maturation [8]. In addition, the expression of acetylcholinesterase -a key factor in erythropoiesis -is increased concurrent to different stages of maturation [9].…”

Section: Discussionmentioning

confidence: 99%

Treatment with Erythropoietin Improves Ineffective Erythropoiesis in a Child with Pyruvate Kinase Deficiency

Wiederer,

Genevaux,

Eber

2024

Preprint

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Background: Pyruvate Kinase Deficiency (PKD) drastically reduces the lifespan of erythrocytes resulting in, inter alia, jaundice, hypersplenism and dependency on regular blood transfusions due to hemolysis. Splenectomy and blood transfusions do not guarantee an improvement of clinical symptoms and cause severe side effects such as iron overload and risk of infection. Procedure: Treatment with EPO was introduced two months after birth and commenced with a dosage of < 200.0 U/kg subcutaneously twice per week. Results: Hemoglobin concentration (Hb) remained stable at 8.0 g/dl at the age of 12 months and reached a peak of 11.0 g/dl at 20 moths. No further transfusions were necessary since the effect of EPO set in. Mean corpuscular volume (MCV) showed a slower increase than the number of reticulocytes proving that treatment with EPO improved the maturation of reticulocytes to adult erythrocytes thereby overcoming ineffective erythropoiesis. Iron overload due to prior transfusions was reduced, hypersplenism and compromised liver function were not present at any time. The child’s health and neurological development were in line with its age always. Conclusions: Treatment with EPO overcomes ineffective erythropoiesis in patients with a measurable residual activity of PK preventing the risks and side effects of current standard treatment strategies

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Erythropoietin increases reticulocyte counts and maintains hematocrit in neonates requiring surgery

Cited by 20 publications

References 29 publications

A Randomized, Masked Study of Weekly Erythropoietin Dosing in Preterm Infants

A Randomized, Masked Study of Weekly Erythropoietin Dosing in Preterm Infants

Blood transfusion risks and alternative strategies in pediatric patients

Treatment with Erythropoietin Improves Ineffective Erythropoiesis in a Child with Pyruvate Kinase Deficiency

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