The anemia of prematurity is a normocytic, normochromic anemia that is
characterized by inadequate production of erythropoietin. Recombinant
erythropoietin has been used to stimulate marrow and reduce the need for
transfusion of autologous blood cells. One study showed a statistically significant
reduction in number and volume of transfusions in preterm infants treated with
erythropoietin. Additionally reticulocyte counts were higher with a higher
hematocrit value at the end of the study in treated patients [12].^ A recent phase
I/II trial of high-dose erythropoietin without iron supplementation showed no
difference in rates of intracranial hemorrhage or periventricular leukoplacia,
necrotizing enterocolitis or retinopathy of prematurity [13]. Erythropoietin
appears to be a safe and important part of a conservative transfusion practice in
neonates. Sample criteria and dosing guidelines are listed below [14].
Criteria for Use
- Gestational age at birth of 30 weeks or less
- Birth weight of 1250 grams or less
- Hematocrit of < 35% at start of treatment
Dosing - 300 units/kg/dose, subcutaneously, 3 times per week
- Alternatively, 300 units/kg/day for 5-10 days may be used
- Supplemental oral iron doses of 4-6 mg/kg/day should be given
Therapy Duration (one criteria must be met) - Corrected gestational age of 34 weeks is met
- 6 weeks of EPO therapy have been completed