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Erythropoietin therapy in children with bronchiolitis and anemia
Brian R Jacobs1, Kim Lyons, Richard J Brilli
1Division of Critical Care Medicine, Children's Hospital Medical Center, Cincinnati, OH 45229, USA. Jacobs@chmcc.org
Insights
Erythropoietin treatment in critically ill children with bronchiolitis did not reduce red blood cell transfusions, despite increasing reticulocyte counts. This suggests erythropoietin is not routinely recommended for this patient group.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Respiratory medicine
Background:
- Critically ill children with bronchiolitis often need red blood cell transfusions.
- Anemia in critical illness can be associated with a blunted erythropoietin response.
- Erythropoietin treatment has shown promise in reducing transfusions in other conditions.
Purpose of the Study:
- To investigate if critically ill children with bronchiolitis and anemia have erythropoietin deficiency.
- To determine if exogenous erythropoietin treatment increases reticulocyte count and hematocrit.
- To assess if erythropoietin reduces red blood cell transfusion needs in this population.
Main Methods:
- Randomized, blinded, placebo-controlled trial conducted in a children's hospital.
- Included critically ill children with bronchiolitis, anemia (hematocrit >2 SD below normal), and respiratory failure.
- Patients received either intravenous erythropoietin or placebo daily, with elemental iron supplementation.
Main Results:
- Forty-four patients completed the study; no significant baseline demographic differences between groups.
- Red blood cell transfusion rates were similar: 45% in the erythropoietin group vs. 50% in the placebo group (p=nonsignificant).
- The erythropoietin group showed a significantly greater increase in reticulocyte count (p=.003) compared to the control group.
Conclusions:
- Erythropoietin treatment did not significantly decrease red blood cell transfusion requirements in children with bronchiolitis and respiratory failure.
- While erythropoietin improved reticulocyte response, it did not translate to reduced transfusion needs.
- Routine recommendation of erythropoietin for this patient population is not supported by these findings.
Objective:
Critically ill children with bronchiolitis often require red blood cell transfusions. Anemia normally results in increased circulating erythropoietin concentrations; however, critical illness has been associated with a blunted erythropoietin response. Treatment with erythropoietin decreases the need for red blood cell transfusion in several disease states. We hypothesized that critically ill children with bronchiolitis and anemia would have a circulating erythropoietin deficiency and that treatment with exogenous erythropoietin would increase reticulocyte count and hematocrit and reduce red blood cell transfusion requirements.
Design:
Randomized, blinded, placebo-controlled trial.
Setting:
Children's hospital.
Patients:
Critically ill children with bronchiolitis, anemia, and respiratory failure. Anemia was defined as a hematocrit >2 SD below normal for age.
Intervention:
Patients were randomized to one of two groups. In the erythropoietin group, patients received daily intravenous erythropoietin. In the control group, patients received daily intravenous placebo. Both groups were treated with elemental iron.
Measurements And Main Results:
Blood for complete blood count, reticulocyte count, and ferritin and erythropoietin concentration was obtained at admission and discharge. Red blood cell transfusions were administered to patients with a persistent oxygen requirement and a hematocrit of <25%. Outcome variables included number of red blood cell transfusions, change in reticulocyte count, ferritin values, and circulating erythropoietin values between groups. Forty-four patients completed the study (mean 3.1 +/- 0.6 months), with a baseline hematocrit of 27.6 +/- 0.5%, ventilator days of 8.2 +/- 0.6, and pediatric intensive care unit length of stay of 9.8 +/- 0.6 days. There were no significant baseline demographic differences between the control and erythropoietin groups. Ten of 22 (45%) children in the erythropoietin group required red blood cell transfusion compared with 11 of 22 (50%) in the control group (p = nonsignificant). The increase in reticulocyte count was greater in the erythropoietin group compared with the control group (2.1 +/- 0.3% to 4.7 +/- 0.7%, p = .003 vs. 2.1 +/- 0.3% to 2.7 +/- 0.5%, p = nonsignificant).
Conclusions:
Despite a favorable reticulocyte and circulating erythropoietin response, red blood cell transfusion requirements were not significantly diminished by erythropoietin treatment in children with bronchiolitis and respiratory failure. Erythropoietin cannot be routinely recommended for this patient population.
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