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Article |

Epoetin Alfa Therapy in Infants Awaiting Heart Transplantation

Robert E. Shaddy, MD; Emily A. Bullock, RN; Lloyd Y. Tani, MD; Garth S. Orsmond, MD; Dixie D. Hunter, RN; Robert D. Christensen, MD
Arch Pediatr Adolesc Med. 1995;149(3):322-325. doi:10.1001/archpedi.1995.02170150102020.
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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±9×10−3 to 105±16×10−3(P<.05). There were no significant changes in leukocyte count (13.4±1.0× 109/L vs 15.1±0.9×109/L), platelet count (402±43×109/L vs 387±39×109/L), or creatinine (53±9 μmol/L [0.6±0.1 mg/dL] vs 53±9 μmol/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.(Arch Pediatr Adolesc Med. 1995;149:322-325)

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