Epoetin alfa therapy in infants awaiting heart transplantation
R. E. Shaddy, E. A. Bullock, L. Y. Tani, G. S. Orsmond, D. D. Hunter and R. D. Christensen
Department of Pediatrics, Primary Children's Medical Center, Salt Lake City.
OBJECTIVE: To determine the safety and efficacy of epoetin alfa therapy in
infants awaiting heart transplantation to minimize the need for blood
transfusions. DESIGN: Prospective case series analysis. SETTING: Pediatric
tertiary care center. PATIENTS: Eleven term infants (4 to 54 days old)
awaiting heart transplantation. INTERVENTION: Infants received 16 courses
of daily epoetin therapy and four subsequent courses of alternate-day
epoetin therapy. RESULTS: Daily epoetin therapy was instituted at 23.6 +/-
4.5 days of age, and the duration of treatment was 13.8 +/- 3.9 days (mean
+/- SEM). During daily epoetin therapy, the hematocrit increased from 0.42
+/- 0.015 to 0.50 +/- 0.019 (P < .001), and the reticulocyte count
increased from 58 +/- 9 x 10(-3) to 105 +/- 16 X 10(-3) (P < .05). There
were no significant changes in leukocyte count (13.4 +/- 1.0 X 10(9)/L vs
15.1 +/- 0.9 X 10(9)/L), platelet count (402 +/- 43 X 10(9)/L vs 387 +/- 39
X 10(9)/L), or creatinine (53 +/- 9 mumol/L [0.6 +/- 0.1 mg/dL] vs 53 +/- 9
mumol/L [0.6 +/- 0.1 mg/dL]) (not significant). Four patients received
blood transfusions during daily epoetin therapy, but the amount of blood
administered to patients was significantly less (0.9 +/- 0.5 mL/kg per day)
than the phlebotomy losses (1.8 +/- 0.4 mL/kg per day) (P < .01). During
alternate-day epoetin therapy, the hematocrit decreased from 0.53 +/- 0.014
to 0.43 +/- 0.019 (P < .05). CONCLUSIONS: Daily epoetin therapy appears
to be effective in maintaining stable hematocrit in infants awaiting heart
transplantation, who generally require multiple transfusions secondary to
iatrogenic blood losses.
