Anemia in the preterm infant: erythropoietin versus erythrocyte transfusion--it's not that simple
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Published on: March 14, 2017
Isabelle Von Kohorn1, Richard A Ehrenkranz
1Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8064, USA.
Insights
Recombinant human erythropoietin (r-EPO) has been explored for treating anemia in premature infants, but initial success was limited. Evolving safety data and transfusion alternatives may alter the cost-benefit analysis of r-EPO therapy.
Area of Science:
- Neonatal Medicine
- Hematology
- Pharmacology
Background:
- Recombinant human erythropoietin (r-EPO) has been investigated since the late 1980s as an alternative to packed red blood cell (RBC) transfusions for anemia of prematurity.
- Early research aimed to eliminate RBC transfusions but yielded limited success in preventing or treating this condition.
Purpose of the Study:
- To review the historical use, efficacy, and safety of r-EPO in treating anemia of prematurity.
- To re-evaluate the cost-benefit analysis of r-EPO therapy in light of new data and alternative treatments.
Main Methods:
- Literature review of studies on r-EPO for anemia of prematurity.
- Analysis of safety concerns and evolving transfusion practices.
- Comparative assessment of r-EPO versus RBC transfusion, considering cost-effectiveness.
Main Results:
- Initial trials showed limited success in eliminating RBC transfusions.
- Emerging safety concerns regarding r-EPO administration have been noted.
- Previous cost-benefit analyses were nearly balanced.
Conclusions:
- The risk-benefit ratio of r-EPO therapy requires ongoing evaluation.
- Advances such as autologous transfusion and blood-sparing technologies may influence future treatment decisions.
- Further research is needed to clarify the optimal role of r-EPO in managing anemia of prematurity.
Abstract:
Since the late 1980s recombinant human erythropoietin (r-EPO) has been studied as an alternative to packed red blood cell (RBC) transfusion for the treatment of anemia of prematurity in very low birth weight infants. Initial trials and reports focused on r-EPO's ability to prevent or treat anemia of prematurity with the goal of eliminating RBC transfusion but achieved limited success. New concerns about the safety of r-EPO administration have emerged. Past cost-benefit analyses of r-EPO administration versus transfusion for the treatment of anemia of prematurity have been nearly balanced. Autologous transfusion, blood-sparing technologies, changes in RBC transfusion technique and safety, and further elucidation of the risk-benefit ratio of r-EPO therapy may change the cost-benefit analysis.
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