Recombinant Human Erythropoietin in the Prevention of Late Anemia in Intrauterine Transfused Neonates With Rh-isoimmunization

Zuppa, Antonio Alberto; Alighieri, Giovanni; Calabrese, Valentina; Visintini, F; Cota, Francesco; Carducci, Chiara; Antichi, Eleonora; Noia, G.; Fortunato, G; Romagnoli, Costantino

doi:10.1097/mph.0b013e3181cf444c

Cited by 24 publications

(9 citation statements)

References 22 publications

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“…In accord with the results of a previous study [22], hypo generative late anemia in our cohort was significantly correlated with the need for more than 2 IUTs. Several previous studies [23][24][25] have reported that the use of IVIG with alloimmunization decreases the duration of hospitalization, the need for ET, and the need for phototherapy However; other recent studies (high quality RCT) have shown that the use of IVIG has no effect on the rate of ET.…”

Section: (33)supporting

confidence: 82%

“…We would like to stress, however, that the use of high-dose IVIG was recently recommended to be used cautiously due to an increased incidence of NEC [29], which we did not note in our group of patients. This indicates the need to investigate the role of other alternative modalities, including intensive phototherapy, limited use of IVIG, and recombinant human erythropoietin [22]. The reported rate of Neurodevelopmental impairment is higher compared to a recent large cohort study [6].…”

Section: (33)mentioning

confidence: 58%

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Fetal Intrauterine Transfusion Therapy: Neonatal Outcomes

Badran¹

2012

J Blood Lymph

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Background and objectives: Intrauterine blood transfusion (IUT) performed for fetal anemia may be associated with adverse neonatal outcomes. This study aimed to describe the clinical outcome of surviving neonates treated with IUT in an area where detailed outcome on neonatal data is limited. Patients and methods:This prospective study included all living newborns treated with IUT at our institution between March 2004 and February 2011. During this period, 30 newborns with a mean gestation age of 35 weeks (range: 25-37 weeks) were admitted with various respiratory, hematological and gastrointestinal morbidities. Results:The survival rate on discharge was 93%. Severe fetal anemia (72.2%) was significantly associated with a low reticulocyte count at birth and the need for respiratory support after birth (P<0.05). The number of IUTs was significantly correlated with the duration of admission (P=0.034) and the presence of hyporegenerative late anemia (P=0.007), but not with other neonatal outcomes or with a low reticulocyte count at birth. Use of intravenous immunoglobulin was significantly associated with an increased rate of top-up transfusion for late anemia and a decreased duration of admission, with no additional positive effects. Conclusion:This study provides evidence on the types of potential neonatal morbidities after IUT therapy and their risk factors, and could be useful to clinicians treating fetuses with intrauterine transfusions and also for counseling parents.

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Section: (33)supporting

confidence: 82%

Section: (33)mentioning

confidence: 58%

Fetal Intrauterine Transfusion Therapy: Neonatal Outcomes

Badran¹

2012

J Blood Lymph

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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%

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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“…8 Low erythropoietin production by the infant may also be contributory to low hemoglobin levels. 9 Late hemolysis can continue to cause low blood counts and elevated bilirubin.…”

Section: Epidemiology and Pathophysiologymentioning

confidence: 99%

Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn

Delaney

Matthews

2015

Hematology

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Hemolytic disease of the fetus and newborn (HDFN) affects 3/100 000 to 80/100 000 patients per year. It is due to maternal blood group antibodies that cause fetal red cell destruction and in some cases, marrow suppression. This process leads to fetal anemia, and in severe cases can progress to edema, ascites, heart failure, and death. Infants affected with HDFN can have hyperbilirubinemia in the acute phase and hyporegenerative anemia for weeks to months after birth. The diagnosis and management of pregnant women with HDFN is based on laboratory and radiographic monitoring. Fetuses with marked anemia may require intervention with intrauterine transfusion. HDFN due to RhD can be prevented by RhIg administration. Prevention for other causal blood group specificities is less studied. Learning Objectives• Explain the fetal and infant clinical findings associated with hemolytic disease of the fetus and newborn (HDFN) • Describe the approach to pregnancy management when a mother has red cell alloimmunization • Discuss the prevention strategies for HDFN Hemolytic disease of the fetus and newborn (HDFN) is rare condition that occurs when maternal red blood cell (RBC) or blood group antibodies cross the placenta during pregnancy and cause fetal red cell destruction. The fetal physiological consequences of severe anemia in the fetus can also lead to edema, ascites, hydrops, heart failure, and death. In less severe cases, the in utero red cell incompatibility can persist postnatally with neonatal anemia due to hemolysis, along with hyperbilirubinemia and erythropoietic suppression. Epidemiology and pathophysiologyThere are an estimated 3/100 000 to 80/100 000 cases of HDFN per year in the United States. 1 The maternal blood group antibodies that cause HDFN can be naturally occurring ABO antibodies (isohemagglutinins), or develop after exposure to foreign RBC; the latter are called blood group alloantibodies. For HDFN to occur, the fetus must be antigen positive (paternally inherited) and the mother must be antigen negative. Several studies have investigated the prevalence of red cell sensitization. In a large series of 22 102 females in the US, 254 (1.15%) of the women were found to have a red cell alloantibodies, of whom 18% had more than one alloantibody. 2 In the Netherlands, the prevalence of red cell alloantibodies detected in the first trimester was 1.2%. 3 The most common cause of blood group incompatibility results from the ABO blood group system, with incompatibility present in up to 20% of infants. 4 However, because anti-ABO antibodies are predominantly IgM class, most are not effectively transported across the placenta. In addition, the A and B antigens are not well developed on fetal red blood cells. Together, this results in a low rate of clinically severe HDFN due to ABO compatibility, although

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Recombinant Human Erythropoietin in the Prevention of Late Anemia in Intrauterine Transfused Neonates With Rh-isoimmunization

Cited by 24 publications

References 22 publications

Fetal Intrauterine Transfusion Therapy: Neonatal Outcomes

Fetal Intrauterine Transfusion Therapy: Neonatal Outcomes

Neonatal management and outcome in alloimmune hemolytic disease

Hemolytic disease of the fetus and newborn: managing the mother, fetus, and newborn

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