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Factors related to transfusion in very low birthweight infants treated with erythropoietin
R F Maier1, M Obladen, D Messinger
1Department of Neonatology, Virchow-Klinikum der Humboldt Universität, Berlin, Germany.
Insights
Recombinant human erythropoietin (rhEPO) reduces but doesn't eliminate transfusions in very low birthweight (VLBW) infants. Minimizing blood loss and iron deficiency are key to improving rhEPO response and reducing transfusions.
Area of Science:
- Neonatal Medicine
- Hematology
- Pediatric Research
Background:
- Recombinant human erythropoietin (rhEPO) is used to reduce red blood cell transfusions in very low birthweight (VLBW) infants.
- However, transfusions are still frequently required, and factors influencing this need are not fully understood.
Purpose of the Study:
- To identify factors associated with red blood cell transfusion decisions in VLBW infants receiving rhEPO.
- To investigate reasons for rhEPO 'non-responders'.
Main Methods:
- Analysis of a subgroup of 120 VLBW infants from the second European Multicentre rhEPO Trial.
- Evaluation of transfusion rates, birthweight, gestational age, initial hematocrit, reticulocyte count, and diagnostic blood loss volume.
Main Results:
- 50% of VLBW infants received at least one transfusion during rhEPO treatment.
- Transfusions were more common in infants with lower birthweight, lower gestational age, lower initial hematocrit, and lower initial reticulocyte count.
- Transfusion rates varied significantly between centers, correlating with the volume of diagnostic blood loss.
Conclusions:
- Birthweight, initial hematocrit, and gestational age are significant predictors for transfusion in VLBW infants on rhEPO.
- Minimizing diagnostic blood loss and preventing iron deficiency are crucial for improving rhEPO efficacy.
- Rational transfusion criteria are needed for preterm infants to optimize rhEPO treatment outcomes.
Abstract:
The need for red cell transfusions is reduced but not eliminated by recombinant human erythropoietin (rhEPO) in very low birthweight (VLBW) infants. To detect factors associated with the decision to transfuse VLBW infants during rhEPO treatment and to explain rhEPO 'non-responders', the subgroup of those 120 VLBW infants who were treated with rhEPO 750 IU/kg per week in the second European Multicentre rhEPO Trial was evaluated. Sixty (50%) infants received at least one transfusion during erythropoietin treatment. Transfusion was frequent in infants with extremely low birthweight (79% for 750-999 g), low gestational age (70% for < or = 28 weeks), low initial haematocrit or low initial reticulocyte count (61% for haematocrit < or = 0.48 and reticulocytes < or = 9%, respectively). Considerable differences among centres were found for sampling blood loss, iron supply, and transfusion rate, which ranged from 13% to 73% and was related to the volume of diagnostic blood loss (19% vs 80% for blood loss < 1 vs > or = 1 ml/kg per day). The prognostic variables birthweight, initial haematocrit, and gestational age were found to be most predictive for transfusion. To improve rhEPO response in VLBW infants, there is a need to minimise diagnostic blood loss, to prevent iron deficiency, and to develop rational criteria for transfusion in preterm infants.