Characterization and differentiation of iron status in anemic very low birth weight infants using a diagnostic nomogram.
BACKGROUND
In the early weeks of life, very low birth weight (VLBW) infants experience intense laboratory blood sampling leading to clinically significant anemia and the need for red blood cell transfusion. Although controversial, treatment with recombinant human erythropoietin (EPO) and iron has been recommended to stimulate erythropoiesis; optimal dosing of EPO and iron is still uncertain.


OBJECTIVE
To assess the validity of a four-quadrant diagnostic plot of iron availability (ferritin index) versus iron demand for erythropoiesis (reticulocyte hemoglobin content, CHr) for differentiating iron status in anemic VLBW infants.


METHODS
Study subjects were enrolled in a previously reported randomized controlled trial of clinically stable VLBW infants <31 weeks' gestation and <1,300 g at birth to receive 18 days of treatment with: group 1: oral iron; group 2: EPO + oral iron, and group 3: EPO + intravenous + oral iron.


RESULTS
At the end of treatment the ferritin index was significantly higher in both EPO groups compared to the control group. By day 18, CHr of the control group declined into the quadrant of the diagnostic plot characteristic of functional iron deficiency and anemia of chronic disease. Both EPO groups ended in the quadrants that are characteristic for latent iron deficiency and iron deficiency anemia, respectively.


CONCLUSIONS
The diagnostic plot for differentiating anemia in VLBW infants may be an informative, clinically useful tool for iron status assessment under different physiologic and therapeutic erythropoietic states. Larger additional studies in difficult patient populations are needed before the clinical utility of this diagnostic procedure can be unequivocally confirmed.
Kasper
David C
DC
Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria. david.kasper@meduniwien.ac.at
Widness
John A
JA
Haiden
Nadja
N
Berger
Angelika
A
Hayde
Michael
M
Pollak
Arnold
A
Herkner
Kurt R
KR
D000284:Administration, Oral; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D001835:Body Weight / Q000187:drug effects; D004359:Drug Therapy, Combination; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use; D005290:Ferric Compounds / Q000008:administration & dosage / Q000627:therapeutic use; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D019102:Infant, Very Low Birth Weight / Q000097:blood*; D007275:Injections, Intravenous; D007501:Iron / Q000097:blood*; D049451:Nomograms; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D012156:Reticulocytes / Q000737:chemistry
D005290:Ferric Compounds; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D005293:Ferritins; D007501:Iron
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