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)