FACTORS RELATED TO TRANSFUSION IN VERY-LOW-BIRTH-WEIGHT INFANTS TREATED WITH ERYTHROPOIETIN

The need for red cell transfusions is reduced but not eliminated by re combinant human erythropoietin (rhEPO) in very low birthweight (VLBW) infants. To detect factors associated with the decision to transfuse V LBW infants during rhEPO treatment and to explain rhEPO 'non-responder s', the subgroup of those 120 VLBW infants who were treated with rhEPO 750 IU/kg per week in the second European Multicentre rhEPO Trial was evaluated. Sixty (50%) infants received at least one transfusion duri ng erythropoietin treatment. Transfusion was frequent in infants with extremely low birthweight (79% for 750-999 g), low gestational age (70 % for less than or equal to 28 weeks), low initial haematocrit or low initial reticulocyte count (61% for haematocrit less than or equal to 0.48 and reticulocytes less than or equal to 9%, respectively). Consid erable differences among centres were found for sampling blood loss, i ron supply, and transfusion rate, which ranged from 13% to 73% and was related to the volume of diagnostic blood loss (19% vs 80% for blood loss <1 vs greater than or equal to 1 ml/kg per day). The prognostic v ariables birthweight, initial haematocrit, and gestational age were fo und to be most predictive for transfusion. To improve rhEPO response i n VLBW infants, there is a need to minimise diagnostic blood loss, to prevent iron deficiency, and to develop rational criteria for transfus ion in preterm infants.