Erythropoietin as Treatment for Late Hyporegenerative Anemia in Neonates with Rh Hemolytic Disease after in utero Exchange Transfusion

Nicaise, C.; Gire, Catherine; Casha, Paul; D’ercole, C.; Chau, C.; Palix, C.

doi:10.1159/000048000

Cited by 23 publications

(15 citation statements)

References 12 publications

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“…The concentration of red blood cells (ie, Hct) commonly increases after 2 to 3 weeks of treatment 7,12 ; in our reported case, we observed a neat Hct increase after 20 days of therapy with rHuEpo. The criteria for stopping rHuEpo therapy are not well defined; our institutional protocol suggests discontinuing the therapy in cases of persistent thrombocytosis (platelets count >600,000/mm 3 ), persistent neutropenia (white cells count <1000/mm 3 ), and arterial hypertension.…”

Section: Discussionsupporting

confidence: 43%

Anti-Rh(c), “Little C,” Isoimmunization

Zuppa

Cardiello

Alighieri

et al. 2013

Journal of Pediatric Hematology/Oncology

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The overall prevalence of non-Rh-D isoimmunization seems to lie between 0.15% and 1.1%. Anti-Rh(c) alloimmunization, "little c," occurs in 0.07% of pregnancies and shows a quite broad clinical presentation. Late anemia is a frequent problem occurring in the setting of isoimmunization. It occurs more frequently after intrauterine blood transfusions or exsanguinotransfusion, and it can be thought as a hyporegenerative anemia. The authors describe the use of human recombinant erythropoietin in preventing late anemia in a case of anti-Rh(c) isoimmunization. The use of human recombinant erythropoietin is a valid tool for preventing late-onset anemia due to either anti-Rh-D or non-anti-Rh-D isoimmunization.

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Section: Discussionsupporting

confidence: 43%

Anti-Rh(c), “Little C,” Isoimmunization

Zuppa

Cardiello

Alighieri

et al. 2013

Journal of Pediatric Hematology/Oncology

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“…The possible explanations of anemia are intramedullary destruction of normoblasts with Rh antibodies and low erythropoietin levels due to suppression of the bone marrow by IUT [1,6,9]. These patients require erythrocyte transfusions in the postnatal period, and the use of rHuEPO may reduce the need for postnatal transfusions [10][11][12][13]. Even though rHuEPO administration is highly effective in many patients, treatment of hyporegenerative anemia with rHuEPO may be ineffective when anti-D titers are high [14].…”

Section: Discussionmentioning

confidence: 99%

Severe iron overload and hyporegenerative anemia in a case with rhesus hemolytic disease: therapeutic approach to rare complications

Demircioğlu¹,

Sözmen²,

Yılmaz³

et al. 2010

Turk J Hematol

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A 33 weeks' gestation, a baby with rhesus hemolytic disease (RHD), who had received intrauterine transfusions twice, developed cholestatic hepatic disease and late hyporegenerative anemia. Her serum ferritin and bilirubin levels increased to 8842 ng/ml and 17.9 mg/dl, respectively. Liver biopsy showed cholestasis and severe iron overload. Treatment with recombinant erythropoietin (rHuEPO) decreased the transfusion need, and intravenous deferoxamine resulted in a marked decreased in serum ferritin levels and normalization of liver function. In patients who have undergone intrauterine transfusions due to RHD, hyperferritinemia and late hyporegenerative anemia should be kept in mind. Chelation therapy in cases with symptomatic hyperferritinemia and rHuEPO treatment in cases with severe hyporegenerative anemia should be considered. (Turk J Hematol 2010; 27: 204-8) Key words: Rhesus hemolytic disease, late hyporegenerative anemia, transfusion-related hepatic iron overload, chelation therapy

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“…EPO is the principle growth factor responsible for fetal and neonatal erythropoiesis and is primarily developed in the fetal liver [70], since over a decade, recombinant human EPO has been applied in small studies and casuistic reports, with different outcomes for the occurrence of anemia and the need for top-up transfusions in neonates with HDFN [71][72][73][74]. Due to limited clinical importance of observed beneficial effects, routine use of EPO is currently not recommended [75].…”

Section: Epomentioning

confidence: 99%

“…This is caused by the combination of prolonged hemolysis and treatment with multiple IUTs and erythrocyte transfusions [72,73,88]. Although iron is essential in early brain development and function, iron overload can have detrimental health effects as well.…”

Section: Iron Overloadmentioning

confidence: 99%

Neonatal management and outcome in alloimmune hemolytic disease

Ree

Smits-Wintjens

Bom

et al. 2017

Expert Review of Hematology

103

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Introduction: Hemolytic disease of the fetus and newborn (HDFN) occurs when fetal and neonatal erythroid cells are destroyed by maternal erythrocyte alloantibodies, it leads to anemia and hydrops in the fetus, and hyperbilirubinemia and kernicterus in the newborn. Postnatal care consists of intensive phototherapy and exchange transfusions to treat severe hyperbilirubinemia and top-up transfusions to treat early and late anemia. Other postnatal complications have been reported such as thrombocytopenia, iron overload and cholestasis requiring specific management. Areas covered: This review focusses on the current neonatal management and outcome of hemolytic disease and discusses postnatal treatment options as well as literature on long-term neurodevelopmental outcome. Expert commentary: Despite major advances in neonatal management, multiple issues have to be addressed to optimize postnatal management and completely eradicate kernicterus. Except for strict adherence to guidelines, improvement could be achieved by clarifying the epidemiology and pathophysiology of HDFN. Several pharmacotherapeutic agents should be further researched as alternative treatment options in hyperbilirubinemia, including immunoglobulins, albumin, phenobarbital, metalloporphyrins, zinc, clofibrate and prebiotics. Larger trials are warranted to evaluate EPO, folate and vitamin E in neonates. Long-term follow-up studies are needed in HDFN, especially on thrombocytopenia, iron overload and cholestasis.ARTICLE HISTORY

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Erythropoietin as Treatment for Late Hyporegenerative Anemia in Neonates with Rh Hemolytic Disease after in utero Exchange Transfusion

Cited by 23 publications

References 12 publications

Anti-Rh(c), “Little C,” Isoimmunization

Anti-Rh(c), “Little C,” Isoimmunization

Severe iron overload and hyporegenerative anemia in a case with rhesus hemolytic disease: therapeutic approach to rare complications

Neonatal management and outcome in alloimmune hemolytic disease

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