Anemia of Prematurity - Portal Neonatal

• Reducing the number of donor exposures: In addition to reducing the number of transfusions,
reducing the number of donor exposures is important. This can be accomplished as follows:
o Use PRBCs stored in preservatives (eg, citrate-phosphate-dextrose-adenine [CPDA-1])
and additive systems (eg, Adsol). Preservatives and additive systems allow blood to be
stored safely for up to 35-42 days. Infants may be assigned a specific unit of blood, which
may suffice for treatment during their entire hospitalization.
o Use volunteer-donated blood and all available screening techniques. The risk of
cytomegalovirus (CMV) transmission can be reduced dramatically (but not entirely)
through the use of CMV-safe blood. This can be accomplished by using either CMV
serology-negative cells or blood processed through leukocyte-reduction filters. This latter
method also reduces other WBC-associated infectious agents (eg, Epstein-Barr virus,
retroviruses, Yersinia enterocolitica). The American Red Cross now is providing
exclusively leukocyte-reduced blood to hospitals in the United States.
Recombinant erythropoietin treatment
• Multiple investigations have established that premature infants respond to exogenously
administered recombinant human EPO with a brisk reticulocytosis. Modest decreases in the
frequency of PRBC transfusions have been documented primarily in premature infants who
are relatively large.
• Recent trials have evaluated the impact of EPO treatment in populations of the most immature
neonates. These studies likewise have demonstrated that infants with VLBW are capable of
responding to EPO with a reticulocytosis and that the drug appears to be safe. Conversely,
the hemoglobin level of infants treated with EPO falls to at or below the hemoglobin level of
the control group within 1 week of treatment cessation, and the impact on transfusion
requirements ranges from nonexistent to small.
• No agreement regarding timing, dosing, route, or duration of therapy exists. In short, the costbenefit
ratio for EPO has yet to be clearly established, and this medication is not accepted
universally as a standard therapy for the individual with AOP. When the family has religious
objections to transfusions, the use of EPO is advisable.
Consultations: Neonatology and Pediatric hematology
Diet: Provision of adequate amounts of vitamin E, vitamin B-12, folate, and iron are important to avoid
exacerbating the expected decline in hemoglobin levels in the premature infant.
MEDICATION Section 7 of 10
Drug Category: Growth factors -- Hormones that stimulate production of red cells from the erythroid
tissues in the bone marrow.
Epoetin alfa (Epogen, Procrit) -- Used to stimulate erythropoiesis and
decrease the need for erythrocyte transfusions in high-risk preterm
neonates. Stimulates division and differentiation of committed erythroid
Drug Name progenitor cells. Induces release of reticulocytes from bone marrow into
blood stream.
Infants require supplemental iron and vitamin E. Some physicians also
use folate.
Adult Dose Mother: 400 U/kg/dose IV/SC 3 times/wk until postconceptional age 35w
72 hours: 200 U/kg/d IV for 14 d
Pediatric Dose 10 days: 200 U/kg/dose SC 3 times/wk for 6 wk
10-35 days: 100 U/kg/d IV 2 times/wk for 6 wk
Contraindications Documented hypersensitivity; uncontrolled hypertension
Interactions None reported
Pregnancy C - Safety for use during pregnancy has not been established.