Induction of fetal hemoglobin synthesis with recombinant human erythropoietin in anemic patients with heterozygous beta-thalassemia during pregnancy.
OBJECTIVE
Recombinant human erythropoietin (rhEPO) increases fetal hemoglobin synthesis in nonpregnant thalassaemic patients. We used rhEPO in 4 pregnant patients with heterozygous beta-thalassemia and anemia to study its effect on erythropoiesis, F cell production, and HbF synthesis.


METHODS
Patients were treated with a combination therapy of rhEPO and iron. The effect on HbF synthesis was assessed by the percentage of F reticulocytes, F cells, and total HbF, erythropietis by reticulocyte count, and hemoglobin measurements and iron status by ferritin levels, transferrin saturation, and percentage of hypochromic red cells.


RESULTS
RhEPO caused an increase of F reticulocytes (1.5 to 10.5 fold), F cells (5.0 to 7.7 fold), and HbF (1.4 to 2.2 fold). All patients showed an increase of young, immature reticulocytes and had elevated reticulocytes at the end of therapy. Hemoglobin increased with a range from 0.3 to 1.5 g/dL. Transferrin saturation and ferritin levels were normal at the end of the study. There was an increase of the percentage of hypochromic red cells, indicating functional iron deficiency after rhEPO administration despite supplemental iron.


CONCLUSIONS
RhEPO stimulates both HbF synthesis and erythropoiesis in pregnant patients with heterozygous beta-thalassemia and anemia. Since it is known that high HbF levels ameliorate thalassemia symptoms in nonpregnant patients, use of rhEPO for the treatment of severe anemia in thalassaemic patients during pregnancy might be further evaluated.
Department of Gynaecology and Obstetrics, Clinic of Obstetrics, University of Zurich, Switzerland. chb@fhk.usz.ch
C
C
Breymann
E
E
Fibach
E
E
Visca
C
C
Huettner
A
A
Huch
R
R
Huch
D000328:Adult; D000740:Anemia / Q000188:drug therapy*; D004909:Erythrocyte Indices; D004921:Erythropoietin / Q000032:analysis / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005319:Fetal Hemoglobin / Q000096:biosynthesis* / Q000187:drug effects; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D010976:Platelet Count; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D011994:Recombinant Proteins; D017701:Reticulocyte Count; D012156:Reticulocytes / Q000187:drug effects; D014168:Transferrin / Q000032:analysis; D017086:beta-Thalassemia / Q000188:drug therapy*
D006454:Hemoglobins; D011994:Recombinant Proteins; D014168:Transferrin; D004921:Erythropoietin; D005319:Fetal Hemoglobin