Recombinant erythropoietin in the prevention of late anaemia in intrauterine transfused neonates with Rh-haemolytic disease

Objective: To evaluate the efficacy of recombinant human erythropoietin (rH uEPO) in prevention of late anaemia due to Rh-haemolytic disease in neonate s subjected to one or more intrauterine transfusions (IUTs). Study Design: Six neonates (GA 28-38 weeks, BW 980-3,360 g), subjected to one or more IUT s for Rh-haemolytic disease, were treated for 3 weeks with rHuEPO (200 U/kg /day, s.c.) after the second week of life to prevent late anaemia and conse quently reduce the need for blood transfusions. All treated neonates were s upplemented weekly with iron, vitamin E and folinic acid, intramuscularly. Results: Of the 6 patients studied, 4 preterm neonates, after commencement of rHuEPO treatment, showed a decrease in Hct values with persistent reticu locytopenia, and consequent need for one or more transfusions with packed a nd filtered red cells (PFRC). These 4 neonates had received a greater blood volume with IUTs than the 2 other term neonates, who, after starting rHuEP O treatment, showed an increase in Hct values and in reticulocyte count, wi th no transfusion requirements after birth (247 +/- 47 vs. 84 +/- 76 ml). C onclusions: Our results seem to correlate the efficacy of erythropoietin tr eatment in prevention of late anaemia resulting from Rh-haemolytic disease to the severity of intrauterine anaemia and to gestational age. Erythropoie tin, in fact, was less effective in cases of severe intrauterine anaemia re quiring a high volume of PFRC; it was also less effective in the preterm ba bies, because of the simultaneous presence of anaemia of prematurity and ot her major diseases.