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Epoetin alfa therapy in infants awaiting heart transplantation
R E Shaddy1, E A Bullock, L Y Tani
1Department of Pediatrics, Primary Children's Medical Center, Salt Lake City.
Insights
Daily epoetin alfa therapy effectively increased hematocrit in infants awaiting heart transplantation, reducing the need for blood transfusions. This treatment is safe and beneficial for managing anemia in this vulnerable population.
Area of Science:
- Pediatric Cardiology
- Neonatology
- Hematology
Background:
- Infants awaiting heart transplantation often require frequent blood transfusions due to iatrogenic blood loss.
- Anemia is a common complication in this patient population, necessitating effective management strategies.
Purpose of the Study:
- To evaluate the safety and efficacy of epoetin alfa in infants awaiting heart transplantation.
- To determine if epoetin alfa therapy can minimize the requirement for blood transfusions in these infants.
Main Methods:
- Prospective case series analysis conducted at a pediatric tertiary care center.
- Eleven term infants (4 to 54 days old) received epoetin alfa therapy.
- Treatment involved daily epoetin alfa for 16 courses, followed by alternate-day therapy.
Main Results:
- Daily epoetin alfa significantly increased hematocrit (0.42 to 0.50, P < .001) and reticulocyte count (P < .05).
- Leukocyte, platelet, and creatinine levels remained stable.
- Blood transfusions were reduced compared to phlebotomy losses (0.9 vs 1.8 mL/kg/day, P < .01).
- Alternate-day therapy led to a decrease in hematocrit (0.53 to 0.43, P < .05).
Conclusions:
- Daily epoetin alfa therapy is effective in maintaining stable hematocrit levels in infants awaiting heart transplantation.
- This therapeutic approach helps mitigate the need for transfusions in infants experiencing iatrogenic blood loss.
Objective:
To determine the safety and efficacy of epoetin alfa therapy in infants awaiting heart transplantation to minimize the need for blood transfusions.
Design:
Prospective case series analysis.
Setting:
Pediatric tertiary care center.
Patients:
Eleven term infants (4 to 54 days old) awaiting heart transplantation.
Intervention:
Infants received 16 courses of daily epoetin therapy and four subsequent courses of alternate-day epoetin therapy.
Results:
Daily epoetin therapy was instituted at 23.6 +/- 4.5 days of age, and the duration of treatment was 13.8 +/- 3.9 days (mean +/- SEM). During daily epoetin therapy, the hematocrit increased from 0.42 +/- 0.015 to 0.50 +/- 0.019 (P < .001), and the reticulocyte count increased from 58 +/- 9 x 10(-3) to 105 +/- 16 X 10(-3) (P < .05). There were no significant changes in leukocyte count (13.4 +/- 1.0 X 10(9)/L vs 15.1 +/- 0.9 X 10(9)/L), platelet count (402 +/- 43 X 10(9)/L vs 387 +/- 39 X 10(9)/L), or creatinine (53 +/- 9 mumol/L [0.6 +/- 0.1 mg/dL] vs 53 +/- 9 mumol/L [0.6 +/- 0.1 mg/dL]) (not significant). Four patients received blood transfusions during daily epoetin therapy, but the amount of blood administered to patients was significantly less (0.9 +/- 0.5 mL/kg per day) than the phlebotomy losses (1.8 +/- 0.4 mL/kg per day) (P < .01). During alternate-day epoetin therapy, the hematocrit decreased from 0.53 +/- 0.014 to 0.43 +/- 0.019 (P < .05).
Conclusions:
Daily epoetin therapy appears to be effective in maintaining stable hematocrit in infants awaiting heart transplantation, who generally require multiple transfusions secondary to iatrogenic blood losses.