RHEPO TREATMENT OF POSTPARTUM ANEMIA

Postpartum hemorrhage is a continuing problem occurring in 5 -10% of a ll deliveries. Due to recent problems with blood transfusion, heterolo gous blood is nowadays restricted to life-threatening indications. As a consequence the clinician is faced with many patients suffering from overt symptoms of anemia. We therefore investigated the effect of rec ombinant human erythropoietin (rhEPO) in combination with adequate iro n supplementation as an alternative for blood transfusion in postpartu m anemia. In a pilot study we could show that rhEPO can enhance the ef fect of endogenous erythropoietin on erythropoiesis. These data could be confirmed in a larger randomized trial. In another study we could s how that rhEPO given s.c. is as effective as i.v.. Measurement of the iron stores, however, demonstrated low values at the end of pregnancy indicating that iron is a limiting factor for erythropoiesis in postpa rtum anemia. In a next study i.v. iron combined with rhEPO showed a gr eater increase in Hb compared to i.v. iron alone. The chosen dose of i .v. iron, however, was too small as shown by the low ferritin levels. We concluded from these previous studies that rhEPO enhances endogenou s erythropoiesis, but so far the effect was only slight (ca 1 g/dl wit hin 14 days); all treated patients developed overt iron deficiency in terms of low ferritin levels despite oral and i.v. iron supplementatio n; no major side-effects were seen. A further study in healthy non pre gnant volunteers demonstrated an effect on erythropoiesis lasting for 3-4 days after a single dose of 300 U/kg rhEPO. Thus in postpartum ane mia the increase in Hb could possibly further be improved using repeat ed doses of rhEPO in combination with high doses of i.v. iron. A prosp ective randomized placebo-controlled double-blind study has been initi ated to test this hypothesis.