RHu-ERYTHROPOIETIN (rH-EPO) IN THE PREVENTION OF ANEMIA OF PREMATURITY: EFFECTS ON ENDOGENOUS ERYTHROPOIESIS

Abstract

Introduction: rH-EPO has been studied as a new treatment regime for the anemia of prematurity in two multicentre studies in order to avoid red cell transfusion with its potential hazards. Methods; We randomly assigned 29 premature infants to 2 treatment schedules with rH-EPO or none. Infants in treatment group 1 (n = 8, mean BW 1436 +/- 357 g, mean GA 31 w) received 70 IU rH-EPO/kgBW/w upto day 25 of life by subcutaneous injection into thigh, those in treatment group 2 (n=6, mean DW 1284 +/-148 g, mean GA 31 w) 750 UI/kgBW/w upto day 42 of life, those in the control group n = 15, mean BW 1327 +/-316 g, mean GA 30 w) received no treatment. All infants received supplemental iron orally from day 14 of life. Results: Mean number of packed red cell transfusions per patient during the study period were 1.4 units (controls), 1.6 units (70 IU group) and 0.17 units (750 IU group). Mean reticulocyte counts were at day 3 of life were 10.1 +/-5 % (controls), 8.8 +/- 4.4 % (75 IU group) and 8.2 +/- 6.5 % (750 IU group). In both the control and the 75 IU group mean reticulocytes count decreased during observation time to mean values between 3 and 4 %, while it increased in the 750 IU group to a highest value of 10.6 +/-2.3 % in week 3 and stayed at a high level of 7 to 8 % until week 5. Mean absolute normocyte count fell in a logarithmic manner but values were higher in both treatment groups. The biggest difference was observed in week 4 with a mean of 180 normocytes in the 750 IU group, 75 in the 75 IU group and only 1G in the control group. Conclusion: Low dose rH-EPO showed no sufficient effect for the treatment of anemia of prematurity. High dose rH-EPO prevents the need for transfusion in preterm infants, stimulates endogenous generation of normovolemic hypochrome erythrocytes and does not stimulate other cell lines than the red cell line.