Erythropoietin versus Restrictive Transfusion Guidelines

S. Stoicescu, M. Detrian

Abstract: The article contains recent data concerning pathophysiology of prematurity anemia, emerged from two clinical studies conducted in the Polizu Department of Neonatology. Finding new ways to decrease the number of transfusions for anemic premature babies admitted in Polizu Intensive Care Unit. In 1998, for the first time in Romania, erythropoietin was used as an alternative therapy in anemia of prematurity, in the neonatal intensive care unit of the Maternity of Polizu. The controversies regarding erythropoietin use in treatment of preterm anemia led to two clinical trials. The first one, conducted in 2001, aimed the effect of erythropoietin in reducing the number of transfusions. The study enrolled 126 preterm babies less than 32 weeks gestation and 1,500 g birth weight; 63 were treated with erythropoietin (EPO) and other 63 - control group, without EPO treatment. The second study, finalized in 2008, tried to ascertain the effect of more restrictive transfusion guidelines in 54 premature newborns not treated with EPO. Both studies showed an important decrease in the number of transfusions required. In 1998-2001 the mean transfusion number for preterm births that did not receive erythropoietin was 4.9 compared to 3.2 for the EPO (+) group (p=0.01 C.I. 95%). In 2008 the number of transfusions decreased even more, the mean number of transfusions being 1.9 (p=0.001, C.I. 95%). Data emerging from both studies demonstrate that improved preterm care, as well as more restrictive transfusion guidelines, is more important in reducing the number of transfusions than EPO therapy. The number of transfusions and transfused volumes were significantly lower when more restrictive red blood transfusion guidelines were applied, compared to EPO treatment.
Keywords: anemia, prematurity, erythropoietin, transfusions, guideline