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Chapter 8 - Anemia of Prematurity and Indications for Erythropoietin Therapy

from Section III - Erythrocyte Disorders

Published online by Cambridge University Press:  30 January 2021

By
Pamela J. Kling
Edited by
Pedro A. de Alarcón ,
Eric J. Werner ,
Robert D. Christensen  and
Martha C. Sola-Visner
Pedro A. de Alarcón
Affiliation:
University of Illinois College of Medicine
Eric J. Werner
Affiliation:
Children's Hospital of the King's Daughters
Robert D. Christensen
Affiliation:
University of Utah
Martha C. Sola-Visner
Affiliation:
Harvard University, Massachusetts
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Summary

Anemia of prematurity is a multifactorial anemia, characterized by relatively low plasma erythropoietin (EPO) levels, iatrogenic blood loss, low circulating blood volumes and insufficient erythropoiesis. This anemia has been long characterized as nutritionally insensitive, but nutrition may influence its clinical course. Anemia of prematurity is treated with erythrocyte transfusions. However, delaying umbilical cord clamping may increase initial hematocrit percentages, improve infant iron status, prevent erythrocyte transfusions, decrease necrotizing enterocolitis (NEC), and decrease intraventricular hemorrhage (IVH). Many published studies have examined the potential of therapy with recombinant human EPO or other erythropoietic stimulating agent (ESA). Although EPO therapy is associated with statistically lower number of total erythrocyte transfusions, most early transfusions are not eliminated. However, early erythropoietic EPO dosing may also decrease NEC and IVH as well as improve neurocognitive outcomes. A recent systematic review refuted previous concerns that early administration of EPO was associated with increased retinopathy of prematurity (ROP). Early high dose EPO regimens are currently being studied for neuroprotection in premature infants. Iron deficiency in EPO treatment is also of potential concern, but long-term iron status of EPO treated premature infants is similar to controls.

Type
Chapter
Information
Neonatal Hematology
Pathogenesis, Diagnosis, and Management of Hematologic Problems
 , pp. 120 - 132
Publisher: Cambridge University Press
Print publication year: 2021

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