ERYTHROPOIETIN

Recormon, Eprex, Epoetin

Reviewed by Dr Jutta van den Boom, Dr Simon Rowley, Brenda Hughes, and Robyn Wilkinson (July 2003)

Indications, contraindications, and special considerations revised by Carl Kuschel

November 2006
Administration Newborn Drug Protocol Index Newborn Services Home Page

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.

Indications

  1. 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

  1. 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.
  2. Parents should be informed of potential risks associated with the administration of erythropoietin.

Clinical Pharmacology

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 adhered to.

Interactions

  1. No known interactions

Possible Adverse Effects

  1. Iron deficiency (which can be prevented by ensuring adequate supplementation).
  2. Neutropenia (self-correcting after stopping treatment) may occasionally occur.
  3. Thrombocytopenia
  4. Thrombocytosis
  5. Hypertension
  6. Early use has been associated with more severe retinopathy of prematurity.

Special Considerations

  1. There are a number of Cochrane systematic reviews evaluating the efficacy of erythropoietin in premature infants.
  2. 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):
  3. For those infants receiving erythropoietin, use in conjunction with

Iron

  1. Commence oral iron when on 75% feeds.
  2. Dose 6mg/kg/day elemental iron (1ml/kg/day of Ferrous sulphate [30mg elemental iron per 5ml])
  3. 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.

Vitamin E

  1. Start when oral iron commenced
  2. Dose 25 IU/day
  3. Given to prevent oxidative haemolysis of red cells.
  4. Do not give simultaneously with iron.

Bloods and Monitoring

  1. FBC (including WBC and platelet count), ferritin and reticulocytes at commencement.
  2. FBC and reticulocyte count weekly.
  3. Ferritin every second week.
  4. Daily blood pressure