DECREASED FERRITIN LEVELS, DESPITE IRON SUPPLEMENTATION, DURING ERYTHROPOIETIN THERAPY IN ANEMIA OF PREMATURITY

Erythropoietin (rHuEPO) therapy has been shown to be beneficial in pre venting and treating anaemia of prematurity and to decrease the need f or blood transfusions. There is, however, only scanty data on the effe ct of rHuEPO therapy on iron metabolism. We studied 29 preterm infants (age 34 +/- 14 days) who were randomly assigned to receive either rHu EPO 900 U kg(-1) week(-1) with 6 mg kg(-1) day(-1) of iron for 4 weeks (n = 15) or no therapy. The following parameters were evaluated and c ompared between and within groups at the beginning, during and at the end of the study: Haematocrit (SI), reticulocytes (109 mu g l(-1)), se rum ferritin (mu g l(-1)) and iron (mu mol l(-1)). The results were as follows. At the baseline, erythropoietin levels were similar in both groups: 7.2 +/- 5.6 versus 6.2 +/- 3.2 mU ml(-1) (NS). In the treated infants the haematocrit remained stable during the study and was signi ficantly higher than in the control group by the end of the study: 0.3 4 +/- 0.03 versus 0.28 +/- 0.05 (p = 0.001). rHuEPO therapy increased the reticulocyte count from 130 +/- 70 to 430 +/- 200 (p = 0.0002). Ho wever, rHuEPO therapy depleted both serum ferritin and iron levels fro m 321 +/- 191 to 76 +/- 58 mu g l(-1) (p = 0.04) and from 18 +/- 5 to 13 +/- 4 mu mol l(-1) (p = 0.03), respectively. We conclude that rHuEP O therapy prevented anaemia and its sequelae; however, serum ferritin and iron levels were depleted. We suggest that the effect of rHuEPO ma y be further increased by higher iron supplementation.