title: Variable efficacy of recombinant human erythropoietin in anemic pregnant women with different forms of heterozygous hemoglobinopathy.
abstract: OBJECTIVE
  The aim of this study was to determine the response to recombinant human erythropoietin (rhEPO) in anemic pregnant women with heterozygous hemoglobinopathies.
  
  
  METHODS
  A prospective study including 19 consecutive pregnant women with anemia and heterozygous hemoglobinopathy was performed. Treatment was divided into two phases: the initial low-dose phase and the subsequent high-rhEPO phase. In the initial phase, 3 x 10,000 U of rhEPO was administered with intravenous iron sucrose. In patients showing a poor response (Hb increase <1 g/dl) to low-dose rhEPO, the rhEPO dose was increased to 20,000 U per treatment in the subsequent phase.
  
  
  RESULTS
  All patients showed stimulation of erythropoiesis as evidenced by an increase in hemoglobin. In 13 patients, a good response to therapy was observed (mean Hb increase 1.6 +/- 0.5 g/dl). In 6 patients, resistance to rhEPO was noted (mean Hb increase 0.5 +/- 0.5 g/dl). The mean gestational age at the start of therapy was 28 weeks of gestation and at the end 32 weeks. The mean duration of a complete therapy was 3.5 weeks (range 2-4.5 weeks). If calculated for body weight, the initial low- rhEPO dose of 160.4 +/- 30.6 U/kg body weight/treatment was increased to 320.9 +/- 61.2 U/kg body weight/treatment in the subsequent phase.
  
  
  CONCLUSIONS
  Response to rhEPO treatment differs widely in anemic pregnant patients with heterozygous hemoglobinopathy. Resistance was observed in anemic pregnant patients with the beta-thalassemia trait originally from the Mediterranean region.
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Obstetric Research, Fetomaternal Hematology Unit, Zurich University Hospital, Zurich, Switzerland. gabriela.bencaiova@usz.ch
authors.forename: Gabriela
authors.initials: G
authors.lastname: Bencaiova
authors.forename: Alexander
authors.initials: A
authors.lastname: Krafft
authors.forename: Tilo
authors.initials: T
authors.lastname: Burkhardt
authors.forename: Christian
authors.initials: C
authors.lastname: Breymann
mesh_terms: D000328:Adult; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006453:Hemoglobinopathies / Q000150:complications / Q000188:drug therapy / Q000235:genetics*; D006579:Heterozygote; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy / Q000209:etiology / Q000235:genetics; D011994:Recombinant Proteins; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin