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Profile of anemia in children after liver transplantation
S Misra1, T B Moore, M E Ament
1Department of Pediatrics, and Dumont-UCLA Liver Transplant Center, Los Angeles, California 90095-1752, USA.
Insights
Anemia is common in children post-liver transplant, often with unknown causes and an inadequate erythropoietin (EPO) response. Elevated vitamin B-12 levels were also observed, warranting further investigation.
Area of Science:
- Pediatric Hematology
- Transplantation Medicine
- Gastroenterology
Background:
- Chronic anemia is a significant concern in children following liver transplantation (OLT).
- The clinical and hematological characteristics of post-OLT anemia in pediatric patients are not well-defined.
Purpose of the Study:
- To investigate the clinical and hematological profile of chronic anemia in children after OLT.
- To identify potential causes and contributing factors to anemia in this population.
Main Methods:
- Prospective study of 56 children with chronic anemia (hemoglobin < 2 SD for > 6 months) post-OLT.
- Comprehensive investigations included hemogram, iron studies, vitamin B-12, folic acid, erythropoietin (EPO) levels, and Coomb's tests.
Main Results:
- Anemia etiology was idiopathic in 32 children, with 4 iron deficiency and 2 viral infections.
- Over half had anemia of unknown cause with an inappropriate EPO response; the normal hematocrit-EPO correlation was lost.
- Elevated serum vitamin B-12 levels were found in 61.5% of participants, higher in those with abnormal liver function.
Conclusions:
- Anemia is prevalent in pediatric OLT recipients, frequently of unknown etiology.
- An inappropriate erythropoietin (EPO) response is characteristic of post-OLT anemia in children.
- Elevated vitamin B-12 levels in anemic post-OLT children require further research.
Background:
Clinical and hematological profile of chronic anemia in children after orthotopic liver transplantation (OLT) is unknown.
Methods:
We prospectively studied children after orthotopic liver transplantation (OLT) with hemoglobin levels < 2 standard deviation of age appropriate mean for > 6 months. Investigations included hemogram, reticulocyte count, peripheral blood smear, serum vitamin B-12, folic acid levels, iron studies, Coomb's tests, serum erythropoietin (EPO) levels, and stool and urine tests for occult blood.
Results:
Fifty-six participants (22 male and 34 female, mean age 82.9 months, range 20-232, mean post-OLT duration 48.8 months, range 6-132) were studied. The causes of anemia were idiopathic (32), iron deficiency (4), viral infections (2, HIV=1, parvovirus=1), and lymphoproliferative disease (2). Fifteen participants showed spontaneous recovery within 1-6 months. Thirty-one children with idiopathic anemia had low or normal EPO levels (mean 7.33 mmicro/L, range <2.5 to 15.9, normal 4-24). When outliers (iron deficiency=4, HIV disease= 1) were excluded, there was no statistical correlation between hematocrits and EPO levels. Serum vitamin B-12 levels (n=52) were elevated (normal 110-930 pg/ml) (mean=1,186 pg/ml) in 32 (61.5%) and were significantly higher in those with abnormal liver function tests.
Conclusion:
Anemia is a common problem in children after OLT. More than half the participants had anemia of unknown etiology with an inappropriate EPO response for the degree of anemia. The normal negative correlation between hematocrit and EPO was lost in these children. The observation regarding serum vitamin B-12 levels requires further study.