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Does early erythropoietin therapy decrease transfusions in anemia of prematurity?
Begüm Atasay1, Ayla Günlemez, Nejat Akar
1Department of Neonatology and Molecular Pathology, Ankara University, Turkey. arsanm@superonline.com
Insights
Early erythropoietin and iron therapy did not significantly reduce transfusion needs in very low birth weight infants. Phlebotomy losses in neonatal intensive care units remain a challenge, limiting the effectiveness of this treatment.
Area of Science:
- Neonatalogy
- Pediatric Hematology
- Pharmacology
Background:
- Very Low Birth Weight (VLBW) infants often require interventions for acute neonatal problems.
- Erythropoiesis induction is crucial for managing anemia in premature infants.
- The role of early erythropoietin treatment in VLBW infants is under investigation.
Purpose of the Study:
- To evaluate the impact of early erythropoietin and iron supplementation on erythropoiesis and transfusion requirements in VLBW infants.
- To assess the efficacy of subcutaneous erythropoietin (600 U/kg/week) and oral iron (3 mg/kg/day) in this population.
Main Methods:
- A randomized controlled trial involving 14 VLBW infants receiving erythropoietin and iron, and 13 VLBW infants receiving placebo.
- Weekly monitoring of hematocrit, reticulocyte counts, and blood volumes for phlebotomy and transfusions.
- Study duration was the first 7-8 weeks of life.
Main Results:
- No significant differences were observed in hematocrit, reticulocyte, or ferritin levels between the groups at therapy completion.
- While the study group had higher blood draw volumes and lower transfusion volumes, these differences were not statistically significant (p>0.05).
- Comparable birth weights and gestational ages were noted between the groups.
Conclusions:
- Early erythropoietin and iron therapy, at the studied doses, were ineffective in reducing transfusion needs in VLBW infants.
- High phlebotomy losses in neonatal intensive care units, particularly in developing countries, limit the potential benefits of such therapies.
- Further research may be needed to optimize treatment protocols or explore alternative strategies for anemia management in VLBW infants.
Objective:
To investigate the effect of early erythropoietin treatment on induction of erythropoiesis and the need for transfusion in Very Low Birth Weight (VLBW) infants with acute neonatal problems.
Methods:
The study group consisted of 14 VLBW prematures with gestational ages less than 32 weeks who were given subcutaneous erythropoietin (600 U/kg per week) and oral iron (3 mg/kg per day) during the first 7-8 weeks of their life, while 13 other VLBW prematures that were given placebo constituted the control group. Weekly hematocrit, (Hct) reticulocyte (Ret) values and the volume of blood drawn and transfused were recorded in the both groups.
Results:
The groups were comparable regarding with birth weights and gestational ages. The volume of the blood drawn (76.8 +/- 42.5 and 37.0 +/- 15.2) was higher and the volume of the transfusions (51.84 +/- 49.30 and 68.84 +/- 41.2) was lower in the study group but the differences between the groups were not significant (p>0.05). The hematocrit, the reticulocyte and the ferritin values were similar in both the groups at the end of the therapy.
Conclusion:
Under the neonatal intensive care circumstances of developing countries where blood volumes needed for laboratory analysis are still very high, phlebotomy losses can not be avoided. Thus early erythropoietin and iron therapy at these doses are not effective in decreasing the need for transfusion and induction of endogenous erythropoiesis.