IRON SUPPLEMENTATION ENHANCES RESPONSE TO HIGH-DOSES OF RECOMBINANT-HUMAN-ERYTHROPOIETIN IN PRETERM INFANTS

Aims-To determine whether iron supplementation would enhance erythropo iesis in preterm infants treated with high doses of human recombinant erythropoietin (r-HuEPO). Methods-Sixty three preterm infants were ran domly allocated at birth to one of three groups to receive: r-HuEPO al one, 1200 IU/kg/week (EPO); or r-HuEPO and iron, 1200 IU/kg/week of r- HuEPO plus 20 mg/kg/week of intravenous iron (EPO+iron); or to serve a s controls. All three groups received blood transfusions according to uniform guidelines. Results-Infants in the EPO+iron group needed fewer transfusions than controls-mean (95% CI) 1.0 (0.28-1.18) vs 2.9 (1.84 -3.88) and received lower volumes of blood-mean (95% CI) 16.7 (4.9-28. 6) vs 44.4 (29.0-59.7) ml/kg. The EPO group also needed lower volumes of blood than the controls-mean (95% CI) 20.1 (6.2-34.2) us 44.4 (29.0 -59.7) ml/kg, but the same number of transfusions, 1.3 (0.54- 12.06) v s 2.9 (1.84-3.88). Reticulocyte and haematocrit values from postnatal weeks 5 to 8 were higher in the EPO+iron than in the EPO group, and bo th groups had higher values than the controls, Mean (SEM) plasma ferri tin was lower in the EPO group-65 (55) mu g/l than in the EPO+iron gro up 780 (182) mu g/l, and 561 (228) mu g/l in the control infants. Conc lusions-Early administration of high doses of r-HuEPO with iron supple ments significantly reduced the need for blood transfusion. Intravenou s iron (20 mg/kg/week in conjunction with r-HuEPO yielded a higher ret iculocyte count and haematocrit concentration after the forth week of life than r-HuEPO alone. Infants treated with r-HuEPO alone showed sig ns of reduced iron stores.