Variable Efficacy of Recombinant Human Erythropoietin in Anemic Pregnant Women with Different Forms of Heterozygous Hemoglobinopathy

Abstract

Objective: The aim of this study was to determine the response to recombinant human erythropoietin (rhEPO) in anemic pregnant women with heterozygous hemoglobinopathies. Methods: A prospective study including 19 consecutive pregnant women with anemia and heterozygous hemoglobinopathy was performed. Treatment wasdivided into two phases: the initial low-dose phase and the subsequent high-rhEPO phase. In the initial phase, 3 × 10,000 U of rhEPO was administered with intravenous iron sucrose. In patients showing a poor response (Hb increase <1 g/dl) to low-dose rhEPO, the rhEPO dose was increased to 20,000 U per treatment in the subsequent phase. Results: All patients showed stimulation of erythropoiesis as evidenced by an increase in hemoglobin. In 13 patients, a good response to therapy was observed (mean Hb increase 1.6 ± 0.5 g/dl). In 6 patients, resistance to rhEPO was noted (mean Hb increase 0.5 ± 0.5 g/dl). The mean gestational age at the start of therapy was 28 weeks of gestation and at the end 32 weeks. The mean duration of a complete therapy was 3.5 weeks (range 2–4.5 weeks). If calculated for body weight, the initial low- rhEPO dose of 160.4 ± 30.6 U/kg body weight/treatment was increased to 320.9 ± 61.2 U/kg body weight/treatment in the subsequent phase. Conclusion: Response to rhEPO treatment differs widely in anemic pregnant patients with heterozygous hemoglobinopathy. Resistance was observed in anemic pregnant patients with the β-thalassemia trait originally from the Mediterranean region.