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Serum erythropoietin concentrations fail to increase after significant phlebotomy losses in ill preterm infants
1Division of Neonatology, University of Florida College of Medicine, Gainesville, USA.
Insights
Preterm infants with significant blood loss do not show an increase in erythropoietin levels. This blunted response may contribute to their high transfusion needs.
Area of Science:
- Neonatal Medicine
- Hematology
- Pediatric Physiology
Background:
- Adults increase erythropoietin production after blood loss to stimulate red blood cell production.
- The response of preterm infants to substantial phlebotomy-induced blood loss is not well understood.
Purpose of the Study:
- To investigate serum erythropoietin concentrations in ill preterm infants experiencing significant phlebotomy-induced blood loss.
Main Methods:
- Serum erythropoietin levels were measured in 11 ill preterm infants (mean weight 1057 +/- 167 gm).
- Measurements were taken as cumulative phlebotomy losses increased (5, 10, and 15 ml/kg).
Main Results:
- Erythropoietin concentrations did not increase in any infants despite accumulating blood loss.
- Concentrations were 68.9 +/- 36.2 mU/ml at 5 ml/kg, decreasing to 17.4 +/- 8.9 mU/ml at 10 ml/kg, and 4.8 +/- 2.6 mU/ml at 15 ml/kg before transfusion.
Conclusions:
- Ill preterm infants exhibit a failure to increase serum erythropoietin in response to significant blood loss.
- This impaired erythropoietin response likely contributes to the frequent transfusion requirements observed in this vulnerable population.
Unlabelled:
OBJECTIVE/STUDY DESIGN: After blood loss, production of erythropoietin in adults increases, which accelerates erythropoiesis and restores the erythroid mass. It is unclear whether preterm infants with large phlebotomy losses have a similar response. We therefore measured serum erythropoietin concentrations in 11 ill preterm infants (1057 +/- 167 gm) as their phlebotomy losses accumulated.
Results:
Before the first transfusion, erythropoietin concentrations were 68.9 +/- 36.2 mU/ml (range 0 to 205 mU/ml) at 5 ml/kg blood out, 17.4 +/- 8.9 mU/ml at 10 ml/kg, and 4.8 +/- 2.6 mU/ml at 15 ml/kg. Erythropoietin concentrations did not increase in any patients despite increasing phlebotomy losses.
Conclusion:
Serum erythropoietin concentrations in ill preterm infants do not increase in the face of significant blood loss. Although the mechanistic explanation for this failure is unclear, it likely contributes to the transfusion requirements of this population.