Anemia of prematurity medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical therapy
The optimal therapy for anemia of prematurity depends on the severity of symptoms. Patients with asymptomatic anemia of prematurity require observation and supportive care, whereas symptomatic patients are treated either with blood transfusion or recombinant erythropoietin (EPO) therapy. [1]
Asymptomatic patients
- Patients with no symptoms, stable vital signs and adequate nutrition require no treatment
- Close monitoring and supportive care is the preferred treatment in asymptomatic infants with anemia of prematurity
- Measures should be taken to maintain adequate levels of Vitamin E, Vitmain B12, Folate, and Iron
- Regular checking of hematocrit is essential in infants with anemia of prematurity until a steady increase in the hematocrit levels has been achieved
Symptomatic patients
Blood transfusion is the mainstay in the treatment of infants with symptomatic anemia of prematurity. Exogenous recombinant human erythropoietin can also be used.
Erythropoietin
- Recombinant human erythropoietin is used in premature infants to decrease the number of complications associated with transfusion therapy
- The subcutaneous route is the preferred route of administration
- Administration through intravenous route results in increased urinary loss
- The preferred regimen is 400U/kg/dose through the subcutaneous route (SC) 3 times a week or 200U/kg/dose through intravenous (IV) route daily
- Preterm infants respond well to EPO with reticulocytosis
- Supplemental iron and folic acid should also be administered
- Periodic measurements of serum iron should be done
- Although it helps in decreasing the number of blood transfusions, it is not universally accepted as the standard therapy for infants with anemia of prematurity
- Erythropoietin (EPO) helps in preventing anemia of prematurity in preterm and low birth weight infants
- Alternatively, Darbepoietin alpha can also be used
Blood Transfusion
- Transfusion therapy is the mainstay in the treatment of anemia of prematurity
- Frequency of transfusions depends on the gestational age and severity of symptoms
- A transient decrease in the erythropoiesis and erythropoietin levels occur after the blood transfusion
- PRBC transfusion results in an increase in systemic oxygen transport and decrease in lactic acid levels, cardiac output, and fractional oxygen extraction
- Significant infectious, hematologic, immunologic, metabolic complications are associated with blood transfusion in infants so standard protocols should be followed
- Complications associated with blood transfusion are hemolysis, infections, fluid overload and electrolyte imbalance, and graft versus host disease