EPOETIN ALFA THERAPY IN INFANTS AWAITING HEART-TRANSPLANTATION

Objective: To determine the safety and efficacy of epoetin alfa therap y in infants awaiting heart transplantation to minimize the need for b lood transfusions. Design: Prospective case series analysis. Setting: Pediatric tertiary care center. Patients: Eleven term infants (4 to 54 days old) awaiting heart transplantation. Intervention: Infants recei ved 16 courses of daily epoetin therapy and four subsequent courses of alternate-day epoetin therapy. Results: Daily epoetin therapy was ins tituted at 23.6+/-4.5 da)is of age, and the duration of treatment was 13.8+/-3.9 days (mean+/-SEM). During daily epoetin therapy, the hemato crit increased from 0.42+/-0.015 to 0.50+/-0.019 (P<.001), and the ret iculocyte count increased from 58+/-9 X 10(-3) to 105+/-16 X 10(-3) (P <.05). There were no significant changes in leukocyte count (13.4+/-1. 0 X 10(9)/L vs 15.1+/-0.9 X 10(9)/L), platelet count (402+/-43 X 10(9) /L vs 387+/-39 X 10(9)/L), or creatinine (53+/-9 mu mol/L [0.6+/-0.1 m g/ dL] vs 53+/-9 mu mol/L [0.61+/-0.1 mg/dL]) (not significant). Four patients received blood transfusions during daily epoetin therapy, but the amount of blood administered to patients was significantly less ( 0.9+/-0.5 mL/kg per day) than the phlebotomy losses (1.8+/-0.4 mL/kg p er day) (P<.01). During alternate-day epoetin therapy, the hematocrit decreased from 0.53+/-0.014 to 0.43+/-0.019 (P<.05). Conclusions: Dail y epoetin therapy appears to be effective in maintaining stable hemato crit in infants awaiting heart transplantation, who generally require multiple transfusions secondary to iatrogenic blood losses.