Management of Late Anemia in Rhesus Hemolytic Disease: Use of Recombinant Human Erythropoietin (A Pilot Study)

Abstract

The management of (Rhesus) hemolytic disease of the fetus and newborn includes intrauterine transfusions to prevent the development of hydrops, treatment of the possible hyperbilirubinemia in the immediate postnatal period, and treatment of late anemia. Low levels of serum erythropoietin due to suppression of the bone marrow by multiple intrauterine transfusions is a suggested mechanism for this anemia. The aim of our study was to test whether recombinant human erythropoietin reduced the need for erythrocyte transfusions in these infants. Twenty infants with Rhesus isoimmunization were blindly randomized to treatment and control groups at the 2nd wk of life. The number of intrauterine and exchange transfusions and demographic data were similar in both groups. The infants in the treatment group received recombinant human erythropoietin, s.c. 200 U/kg of body weight three times a week for a period of 6 wk, whereas the infants in the control group received a placebo for the same period. In the treatment group, the mean number of erythrocyte transfusions was significantly lower than that of the control group (1.8 versus 4.2). The reticulocyte counts and Hb levels rose earlier in the treatment group. The platelet and neutrophil counts were similar in both groups throughout the study. This study demonstrates that recombinant human erythropoietin treatment decreases the need for erythrocyte transfusions in the late anemia of infants with Rh isoimmunization. Considering the risks of blood transfusions, this decrease in the donor exposure is worthwhile.

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

“…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].…”

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

“…Ohls et al [5] started EPO treatment at day 85 of life, but some authors started earlier (first or second week of life) [31]. On the other hand, Ovali et al [7] suggested that EPO treatment could be individualized because some patients develop anemia earlier than others.…”

“…Ohls et al [5] were the first to report the use of EPO in vivo as treatment for the late hyporegenerative anemia of Rh hemolytic disease in 2 patients. Ulteriorly, three more studies [3,6,7] described the use of EPO therapy. Only one of these studies was controlled [7], including 20 newborns (10 in each group), and showed that the treatment decreased the need for erythrocyte transfusions.…”

“…It is characterized by low levels of reticulocytes and low erythropoietin (EPO) concentrations [2,4]. A few authors reported use of recombinant human EPO (rHuEPO) as treatment or even for the prevention of this anemia [3,[5][6][7]. We report the results obtained with rHuEPO in treating late hyporegenerative anemia in 2 neonates with Rh hemolytic disease; both patients had received several IUETs.…”

Quelle place reste-t-il pour l’érythropoïétine en néonatalogie ?

“…Depuis, bien d'autres bénéfices ont été mis en avant : l'aspect thérapeutique dans les incompatibilités maternofoetales [1], mais aussi récemment l'aspect neuroprotecteur dans le cadre des anoxo-ischémies périnatales [2].…”