Recormon, Eprex, Epoetin
|Reviewed by Dr
Jutta van den Boom, Dr Simon Rowley, Brenda Hughes, and Robyn Wilkinson
and special considerations revised by Carl Kuschel
Dose and Administration
1. 250 units/kg/dose
two-times per week (Monday/Friday) SC. Total weekly dose 500 units/kg.
Continue for 4-6 weeks.
- Please chart appropriate
generic name. The particular preparation in use at present is Recormon
- Although other preparations
(Trade name: Eprex - Generic name: Epoetin alpha) are available, they are
not currently in use in National Women's NICU.
- Prevention of blood transfusion
in the treatment of anaemia of prematurity (reduced reticulocyte count,
normochromic, normocytic, no haemolysis) in infants whose parents are
unwilling to give consent for the administration of blood products (see
Guidelines for Red Blood Cell Transfusion).
Contraindications and Precautions
- Prescription of erythropoietin
should be discussed with the parents and a verbal consent for treatment
needs to be obtained. A record of this discussion should be documented
in the clinical record.
- Parents should be informed of potential risks associated with the
administration of erythropoietin.
Erythropoietin is a natural
glycoprotein produced primarily in the kidneys which stimulates red blood cell
production. During fetal life it is mostly produced in the liver. Extremely
premature infants experience a lack of erythropoietin and therefore reduced
erythropoiesis. With administration of exogenous erythropoietin red blood cell
production is stimulated. Historically it has been shown to reduce the number of
blood transfusions, but not within the first two weeks of life. It also has not
been shown to avoid transfusions altogether. It seems to be safe, but not cost
effective. The aim of exogenous administration of erythropoietin is to avoid
blood transfusions and/or to reduce donor exposure). At the same time measures
to reduce blood loss (avoid unnecessary blood tests, development of small volume
blood tests) should be initiated and blood transfusions protocols should be
- No known interactions
Possible Adverse Effects
- Iron deficiency (which can be prevented by ensuring adequate supplementation).
- Neutropenia (self-correcting after stopping treatment) may occasionally occur.
- Early use has been associated with more severe
retinopathy of prematurity.
- There are a number of Cochrane systematic reviews evaluating the
efficacy of erythropoietin in premature infants.
- Early use (<8 days) reduces the use of one or more RBC transfusions,
the volume of RBC transfused, and the number of donors and transfusions
the infant is exposed. Reductions in these outcomes are small and
are of limited clinical importance. Of some concern, this review
demonstrated a significant increase in the incidence of Stage 3 (or
greater) ROP when compared to a group of infants receiving placebo.8
Early use is also associated with an increased risk of ROP when compared
to late use.9
- Late administration (>7 days) similarly reduces the use of one or more
RBC transfusions, the number of RBC transfusions per infant and the total
volume of RBC transfused per infant. The clinical importance of the results
for the latter two outcomes is marginal (<1 transfusion per infant and 7
ml/kg of transfused RBC).10
- Strategies for reducing blood loss and decreasing donor exposure in
preterm infants should be utilised in preference to erythropoietin use.
These include (but are not limited to):
- Minimising blood loss around the time of delivery
- Delayed cord clamping
- Reducing unnecessary blood sampling
- Adherence to
blood transfusion guidelines
- Use of "multipacks"
from a single donor
- For those infants receiving erythropoietin, use in conjunction with
- Commence oral iron when on 75% feeds.
- Dose 6mg/kg/day elemental iron (1ml/kg/day of
Ferrous sulphate [30mg elemental iron per 5ml])
- Increase iron to 9 or 12 mg/kg/day if ferritin below 100 μg/L.
Note: Patients with
chronic lung disease may require less iron depending on number of
transfusions received. Use ferritin level as a guide to dosage.
- Start when oral iron commenced
- Dose 25 IU/day
- Given to prevent oxidative haemolysis of red cells.
- Do not give simultaneously with iron.
Bloods and Monitoring
- FBC (including WBC and platelet count), ferritin and reticulocytes at commencement.
- FBC and reticulocyte count weekly.
- Ferritin every second week.
- Daily blood pressure