Begüm ATASAY, Saadet ARSAN, Şükrü CİN, Ayla GÜNLEMEZ, Nejat AKAR

Erythropoietin treatment in higgh and low risk very low birth weight preterms

Amaç: Bu çalışmada hastalık ciddiyetinin eritropoez üzerine etkisi sorgulanmaktadır. Method: Çalışmaya 23 çok düşük doğum ağırlıklı preterm bebek alındı. Yüksek risk kriterleri olarak; intrapartum asfıksi öyküsü, birden fazla sepsis atağı, 72 saatten uzun süreli mekanik ventilasyon tedavisi, patent ductus arterious varlığı kabul edildi. Bu kriterlerden en az birini taşıyan 10 bebek yüksek riskli grubu (Grup f), bu kriterlerden hiç birini taşımayan 13 bebek ise düşük riskli grubu (Grup II) oluşturdu. Bütün bebeklere yaşamın l .haftasından itibaren 6-7 hafta süreyle eritropoetin ve demir tedavisi uygulandı. Eritrosit transfüzyonları 0.30 altındaki hematokrit değeri ve anemiye bağlı semptomların varlığında uygulandı. Hematokrit, retikülosit değerleri ve serum transferrin reseptör düzeyleri eritropoez uyarımının değerlendirilmesinde kullanıldı.Sonuçlar: Gruplar arasında doğum ağırlığı farkı yoktu. Grup I 'in gestasyon yaş ortalaması anlamlı düşük (p=0.0028), toplam transfüzyon ve flebotomi hacimleri ise anlamlı yüksek (p=0014 ve p=0.001) bulundu. Çalışma sonu serum transferrin reseptör düzeyleri grup I'de anlamlı düşük (p=0.0:349) bulundu. Yorum: Daha düşük gestasyon yaşı ve daha yüksek risk kriterlerine sahip çok düşük doğum ağırlıklı pretermler artmış flebotomi kayıpları sonucu daha fazla transfüzyona maruz kalmaktadır. Bu eritropoezin, eritropoetin tedavisi ile daha az uyarılmasına neden olabilir.

Yüksek ve düşük riskli çok düşük doğum ağırlıklı pretermlerde eritropoetin tedavisi

Purpose: The question addressed in this study is whether illness severity affects erythropoiesis. Methods: Twenty-three very low birth weight (VLBW) infants were included in this study. History ofintrapartum asphyxia, more than one septic episode, need for mechanical ventilation for more than 72 hours or presence of patent ductus arterious were selected as high risk criteria. Ten l/LBW infants were assigned to the high risk group (Group I) while the other 13 without these criteria constituted the low risk group (Group II) All the infants received erythropoietin and iron starting at the end of the ]st week for 6-7 weeks. They received erythrocyte transfusions when a hematocrit of less than 0.30 and signs and symptoms attributed to anemia were present. Hematocrit, reticulocyte counts and serum transferlin receptor (TfR) concentrations were evaluated for the assessment of erythropoiesis stimulation between the groups. Results: There were no significant differences between the groups with regard to birth weight, but the gestational age of group I was significantly lower (p=0.0028) and total phlebotomy and transfusion volumes were significantly higher in group I ( p=0.0014 and p=0.001) Hematocrit values and reticulocyte counts were similar at the beginning during and at the end of this study. Serum TfR concentration was significantly lower in group f at the end of this study (p=0.0349). Conclusion: High risk VLBW preterms with lower gestational age are prone to higher transfusion need due to higher volumes of phlebotomy. This may result in less successful stimulation of erythropoiesis with erythropoietin.

PDF

___

1. Doyle JJ. The role of erythropoietin in the anemia of prematurity. Sem Perinatal 1997; 21: 20-27.
2. Messer J, Haddad J, Donato L, Astruct D, Matis J. Early treatment of premature infants with recombinant human erythropoietin. Pediatrics 1993; 92: 519-523.
3. Arsan S, Ecevit A, Tarcan A, Ertogan F, Cin Ş. Recombinant human erythropoietin therapy in veiy low birth weight infants (abstract). XlVth Meeting of the International Society of Haematology, European and African Division Stockholm, Sweden, Aug 30-Sept 4,1997; Abstract Book pp:20.
4. Asch J, Wedgewood JF. Optimizing the approach to anemia in preterm infants. J Perinatal 1997; 17: 276-82.
5. Ehrenkranz RA, Sherwonit EA, Nelli CM. Recombinant human rythropoietin stimulates incorporation of absorbed iron into RBC's in VLBW infants. Pediatr Res 1994; 35:311 A.
6. Carpani G, Biscaglia M, Ghisoni L. Soluble transferrin receptor in the study of fetal erythropoietic activity. Am J Hematol 1996; 52: 192-196.
7. Kumar P, Shankaran S, Krishnan RG. Recombinant human erythropoietin therapy for treatment of anemia prematurity in very low birth weight infants: A randomised, double blind, placebo controlled trial. J Perinatol 1998; 18: 173-177.
8. Tarcan A, Arsan S, Ecevit A. Risk factors, need for transfusion and progress of anemia of prematurity in very low birth weight infants, (abstract) XlVth Meeting of the International Society of Haematology, Europiean and African Division Stockholm, Sweden, Aug 30-Sept 4,1997; Abstract Book pp: 207.
9. Soubasi V, Kremenepoulus G, Diamendi E. In which neonates does recombinant human erythropoietin treatment prevent anemia of prematurity: results of a randomised controlled study. Pediatr Res 1993; 34: 675-79.
10. Bechensteen AG, Haga P, Halvorsen S, Liestol K, Lindemann R, Whitelaw A, Tollofsrud PA, Daae L, Thorstensen K, Sundal E. Effect of low and moderate doses of recombinant human erythropoietin on the haematological response in premature infants on a high protein and iron intake. Eur J Pediatr 1997; 156: 56-61.
11. Brown MS, Keith JF. Comparison between two and five doses a week of recombinant human erythropoietin for anemia of prematurity. A randomised trial. Pediatrics 1999; 104: 210-215.
12. CarnielliV, Montini G, Da Riol R, Dall'Amico R, Cantarutti F. Effect of high doses of human recombinant erythropoietin on the need of blood transfusions in preterm infants. J Pediatr 1992; 121: 98-102.
13. Bader D, Blondheim O, Jonas R, Admoni O, Abend Winger M, Reich D, Lanir A, Tamir A, Eldar I, Attias D. Decreased ferritin levels, despite iron supplementation,during erythropoietin therapy in anemia of prematurity. Acta Pediatr 1996; 85: 496-501.
14. Macdougall IC, Cavill I, Hulme B. Detection of iron deficiency during erythropoietin treatment:a new approach. BMJ 1992; 304: 225-226.
15. Meyer MP, Haworth C, Meyer JH, Commerford A. A comparison of oral and intravenous iron supplementation in preterm infants receiving recombinant human erythropoietin. J Peditr 1996; 129: 258-263.
16. Bechensteen AG, Haga P, Halvorsen S, Horsen S, Whitela A, Liestol K, Lindemann R, Grogaard J, Hellebostad M,Saugstad OD, Gronn M, et al. Erythropoietin, protein, and iron supplementation and the prevention of anemia of prematurity. Arch Dis Child 1993; 69: 19-23.
17. Huebers HA, Beguin Y, Pootrakul P, Einsphar D, Finch CA. Intact transferrin receptors in human plasma and their relation to erythropoiesis. Blood 1990; 75: 102-107.
18. Kiviviori SM, Heikinheimo M, Teppo A, Sumes MA.Early rise in serum concentration of transferrin receptor induced by human recombinant erythropoietin in very low birth weight infants. Pediatr Res 1994; 36: 85-89.
19. North M, Dallalio G, Donath AS, Melink R, Means RT. Serum transferrin receptor levels in patients undergoing evaluation of iron stores. Correlation with other parameters and observed versus predicted results. Clin Lab Haem 1997; 19: 93-97.