Effectiveness of recombinant erythropoietin and iron sucrose vs. iron therapy only, in patients with postpartum anaemia and blunted erythropoiesis

Background To compare efficacy between recombinant human erythropoietin (rh EPO) plus parenteral iron vs. iron alone (parenteral vs. oral) in postpartu m anaemia. Methods Sixty patients (haemoglobin 8.6 +/- 1.1 g dL(-1)) were randomized t o rhEPO plus intravenous (i.v.) iron sucrose (group 1), rhEPO placebo plus i.v. iron sucrose (group 2), or oral iron alone (group 3), daily for 4 days beginning 48-72 h postpartum. Erythropoiesis and iron status were assessed before, and on 4, 7 and 14 days after, starting therapy. Results On day 7 the group 1 haematocrit increase was 7.7 +/- 3.1% vs. 5.3 +/- 1.9% (group 2, P < 0.01) and 4.4 +/- 3.2% (group 3, P < 0.01), and on d ay 14, 11.3 +/- 2.9% vs. 9.2 +/- 3.4% (group 2, P < 0.05) and 8 +/- 2.8% (g roup 3, P < 0.01). The odds of achieving a target haematocrit > 32% on day 7 and > 35% on day 14 were higher on rhEPO (1.5-2.7) than on either iron re gimen alone. Group 1 reticulocyte counts were also higher on days 4 (P < 0. 05 vs. oral iron) and 7 (P < 0.01 vs. oral and parenteral iron). Conclusion All three regimens were effective in postpartum anaemia, but the haematocrit and reticulocyte responses to rhEPO plus parenteral iron were significantly greater than to iron alone. Benefit was greatest in the blunt ed erythropoiesis subgroup with elevated post-Caesarean section C-reactive protein levels.