title: Erythropoietin therapy in children with bronchiolitis and anemia.
abstract: OBJECTIVE
  Critically ill children with bronchiolitis often require red blood cell transfusions. Anemia normally results in increased circulating erythropoietin concentrations; however, critical illness has been associated with a blunted erythropoietin response. Treatment with erythropoietin decreases the need for red blood cell transfusion in several disease states. We hypothesized that critically ill children with bronchiolitis and anemia would have a circulating erythropoietin deficiency and that treatment with exogenous erythropoietin would increase reticulocyte count and hematocrit and reduce red blood cell transfusion requirements.
  
  
  METHODS
  Randomized, blinded, placebo-controlled trial.
  
  
  METHODS
  Children's hospital.
  
  
  METHODS
  Critically ill children with bronchiolitis, anemia, and respiratory failure. Anemia was defined as a hematocrit >2 SD below normal for age.
  
  
  METHODS
  Patients were randomized to one of two groups. In the erythropoietin group, patients received daily intravenous erythropoietin. In the control group, patients received daily intravenous placebo. Both groups were treated with elemental iron.
  
  
  RESULTS
  Blood for complete blood count, reticulocyte count, and ferritin and erythropoietin concentration was obtained at admission and discharge. Red blood cell transfusions were administered to patients with a persistent oxygen requirement and a hematocrit of <25%. Outcome variables included number of red blood cell transfusions, change in reticulocyte count, ferritin values, and circulating erythropoietin values between groups. Forty-four patients completed the study (mean 3.1 +/- 0.6 months), with a baseline hematocrit of 27.6 +/- 0.5%, ventilator days of 8.2 +/- 0.6, and pediatric intensive care unit length of stay of 9.8 +/- 0.6 days. There were no significant baseline demographic differences between the control and erythropoietin groups. Ten of 22 (45%) children in the erythropoietin group required red blood cell transfusion compared with 11 of 22 (50%) in the control group (p = nonsignificant). The increase in reticulocyte count was greater in the erythropoietin group compared with the control group (2.1 +/- 0.3% to 4.7 +/- 0.7%, p = .003 vs. 2.1 +/- 0.3% to 2.7 +/- 0.5%, p = nonsignificant).
  
  
  CONCLUSIONS
  Despite a favorable reticulocyte and circulating erythropoietin response, red blood cell transfusion requirements were not significantly diminished by erythropoietin treatment in children with bronchiolitis and respiratory failure. Erythropoietin cannot be routinely recommended for this patient population.
authors.affiliation: Division of Critical Care Medicine, Children's Hospital Medical Center, Cincinnati, OH 45229, USA. Jacobs@chmcc.org
authors.forename: Brian R
authors.initials: BR
authors.lastname: Jacobs
authors.forename: Kim
authors.initials: K
authors.lastname: Lyons
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Brilli
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology*; D001803:Blood Transfusion; D001988:Bronchiolitis / Q000150:complications* / Q000628:therapy; D016009:Chi-Square Distribution; D016638:Critical Illness / Q000628:therapy; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D004921:Erythropoietin