Recombinant Human Erythropoietin Stimulates Erythropoiesis and Reduces Erythrocyte Transfusions in Very Low Birth Weight Preterm Infants

Abstract

Design and methods. We hypothesized that treatment with recombinant human erythropoietin (r-HuEPO) would stimulate erythropoiesis and would thereby reduce the need for erythrocyte transfusions in preterm infants. We treated 157 preterm infants born at 26.9 ± 1.6 weeks of gestation who weighed 924 ± 183 g at birth with either subcutaneous r-HuEPO (100 U/kg/d, 5 days per week) or placebo for 6 weeks in a randomized, double-blind, controlled clinical trial. All patients received oral iron and were managed according to uniform conservative transfusion guidelines. Results. Treatment with r-HuEPO was associated with fewer erythrocyte transfusions (1.1 ± 1.5 per infant in the r-HuEPO group versus 1.6 ± 1.7 per infant in the placebo group; P = .046) and with a reduction in the volume of packed erythrocytes transfused (16.5 ± 23.0 mL versus 23.9 ± 25.7 mL per infant; P = .023). Overall, 43% of the infants in the r-HuEPO group and 31% of placebo-treated infants were transfusion-free during the study (P = .18). The volume of blood removed for laboratory tests and the need for respiratory support at the start of treatment had major effects on transfusion requirements independent of r-HuEPO. Reticulocyte counts were higher during treatment in the r-HuEPO group (P = .0001), and r-HuEPO-treated infants had higher hematocrit values at the end of the study (32% versus 27.3% in the placebo group; P = .0001). We found no differences in the incidence of major complications of prematurity between the treatment groups. Conclusion. We conclude that treatment with r-HuEPO at a weekly dose of 500 U/kg stimulates erythropoiesis, moderates the course of anemia, is associated with a reduction in erythrocyte transfusions, and appears safe in very low birth weight preterm infants who are receiving iron supplements. Conservative transfusion criteria, minimization of phlebotomy losses, and treatment with r-HuEPO are complementary strategies to reduce erythrocyte transfusions in these infants.

Predictors of mortality and major morbidities in extremely low birth weight neonates

“…Hypotensive shock was defined as per Zubrow's charts when systolic and/or diastolic blood pressure (BP) was <5 th centile for the particular gestational age, weight and postnatal age [13]. Packed red blood cell transfusion was given when PCV <35% in sick neonates and <21% in asymptomatic neonates [14].…”

Pattern, Complications and Social Problems of Blood Transfusion in the Neonatal Unit of a Tertiary Hospital in Southern Nigeria

“…This physiologic phenomenon is experienced usually between 4-12 weeks of age as a result of inadequate materno-fetal iron transfer as well as poor production of endogenous erythropoietin in the postnatal period [36,37]. It is pertinent to note that in developed countries, recombinant human erythropoietin is commonly used thus preventing repeated blood transfusion [38]. This is however not the case in developing countries including Nigeria where the use of erythropoietin is rare as it is not readily available and in centres where it is available, it is expensive thus out of reach of the poor [13].…”

Preterm Infants on Early Solid Foods and Iron Status in the First Year of Life—A Secondary Outcome Analysis of a Randomized Controlled Trial

“…Small for gestational age was defined as birth weight <10th percentile. During hospital stay, anemia was diagnosed as soon as transfusions or a therapy with erythropoietin were needed according to the recommendations of Shannon et al [19]. Erythropoietin therapy (either 300 I.E./day i.v.…”