USE OF RECOMBINANT-HUMAN-ERYTHROPOIETIN IN COMBINATION WITH PARENTERAL IRON IN THE TREATMENT OF POSTPARTUM ANEMIA

The authors compared the effect of recombinant human erythropoietin (r hEPO) in combination with iron with that of iron therapy only in the t reatment of postpartum anaemia. Ninety patients (30 patients/group) re ceived either rhEPO (300 Ukg(-1), i.v. or s.c., once) and iron (parent eral and oral), or iron therapy only. Erythropoiesis was assessed by h aemoglobin and haematocrit increase, absolute reticulocyte counting an d reticulocyte flow cytometry. Ferrokinetics was assessed by serum fer ritin, transferrin and transferrin saturation measurements. There was no difference before therapy for baseline haematological values or iro n status. Patients with endogenous EPO levels below 145 mU mL(-1) had a significant benefit from intravenous rhEPO administration with highe st haematocrit and haemoglobin levels 4 and 14 days after therapy. rhE PO-treated groups showed a higher absolute reticulocyte count and 4 da ys after therapy and an elevated percentage of high fluorescent reticu locytes (HFRs). Parenteral iron therapy caused a significant increase of ferritin and transferrin saturation, while transferrin concentratio n decreased. Ferritin and transferrin levels were lowest after i.v. ad ministration of rhEPO, 1 and 4 days after therapy. C-reactive protein concentration was highest in patients who underwent caesarean section until the end of the observation period. A single dose of rhEPO in com bination with iron was more effective in treating postpartum anaemia t han iron therapy only, in patients who had low EPO levels despite peri partal blood loss. Postpartum low endogenous EPO levels might be a con sequence of inhibiting inflammatory cytokines that are released after spontaneous or operative deliveries.