Hyporegenerative anemia associated with Rh hemolytic disease: treatment failure of recombinant erythropoietin.
A postnatal hyporegenerative anemia may complicate Rh hemolytic disease. Intramedullary hemolysis, bone marrow suppression, and erythropoietin deficiency have been implicated etiologically. Treatment with recombinant erythropoietin (r-EPO) has yielded encouraging preliminary results. The authors describe an infant with Rh isoimmunization who developed severe hyporegenerative anemia unresponsive to a 5-week course of r-EPO. Two additional doses at 12 weeks resulted in brisk reticulocytosis, coinciding with a 16-fold decline in the anti-Rh(D) antibody titer. Thus, treatment with r-EPO may be ineffective when anti-Rh(D) antibody titers are high. The authors also show that erythropoietin deficiency in hyporegenerative anemia is not as frequent and severe as originally thought.
Pessler
Frank
F
Department of Pediatrics, Pediatric Hematology/Oncology Program, NYU School of Medicine, Bellevue Hospital Center, 1st Avenue at 26th Street, New York, NY 10016, USA. pesslf01@popmail.med.nyu.edu
Hart
David
D
D000328:Adult; D000740:Anemia / Q000188:drug therapy / Q000209:etiology*; D001805:Blood Transfusion, Intrauterine; D002780:Cholestasis, Intrahepatic / Q000151:congenital; D004351:Drug Resistance; D004899:Erythroblastosis, Fetal / Q000097:blood*; D017707:Erythrocyte Transfusion; D004920:Erythropoiesis / Q000187:drug effects / Q000276:immunology; D004921:Erythropoietin / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D005293:Ferritins / Q000032:analysis; D006529:Hepatomegaly / Q000151:congenital; D006801:Humans; D007112:Immunity, Maternally-Acquired; D007231:Infant, Newborn; D019190:Iron Overload / Q000097:blood / Q000209:etiology; D007518:Isoantibodies / Q000097:blood*; D007567:Jaundice, Neonatal / Q000097:blood / Q000628:therapy; D010789:Phototherapy; D011247:Pregnancy; D011994:Recombinant Proteins; D017701:Reticulocyte Count; D012203:Rh Isoimmunization / Q000097:blood*; D018029:Rho(D) Immune Globulin; D013997:Time Factors
D007518:Isoantibodies; C061961:RHO(D) antibody; D011994:Recombinant Proteins; D018029:Rho(D) Immune Globulin; D004921:Erythropoietin; D005293:Ferritins