INDUCTION OF FETAL HEMOGLOBIN BY EPO GIVEN IN PRETERM NEONATES FOR THE PREVENTION OF ANEMIA OF PREMATURITY

Purpose: The goal of the study was to estimate if erythropoietin (EPO) stimulates hemoglobin F (HbF) synthesis, given that administration of erythropoietin (EPO) in baboons resulted in stimulation of fetal hemo globin (HbF) synthesis shown by an increase in hemoglobin F-containing cell (F cell) production. It is known also that induction of F cells is dependent on the dose of EPO. High doses of EPO increase the freque ncy of erythroid progenitors programmed to produce HbF. Patients and m ethods: We estimated red cell parameters and HbF-containing cells (%) in 78 premature infants in a controlled randomized trial of recombinan t human erythropoietin (r-HuEPO) administration for the prevention of anemia of prematurity (AOP). Eighteen infants received a high (750unit s/kg/wk) and 30 infants received a low dose (300units/kg/wk). The rema ining 30 infants were used as controls. The infants with birth weight < 1500g and gestational age less than or equal to 31wk were grouped ac cording to the number of transfusions (group I: transfusions < 3, grou p II: transfusions greater than or equal to 3). HbF levels were measur ed every week during EPO treatment and then in the 12th, 24th, and 48t h weeks of life. Results: EPO stimulated endogenous generation of eryt hrocytes with significantly higher mean corpuscular volume (MCV) and l ower mean corpuscular hemoglobin concentration (MCHC) compared with co ntrol infants. The effect of EPO in HbF production was apparent in gro up II because of the multiple transfusions, which resulted in depletio n of HbF and repletion by adult hemoglobin (HbA). Conclusion: EPO sign ificantly stimulated HbF synthesis compared with controls and its indu ction was dose-dependent but without any correlation between physiolog ic parameters and percentage of HbF-containing cells. The practical re levance of this observation is unclear and needs further investigation .