title: Very low birth weight infants qualifying for a 'late' erythrocyte transfusion: does giving darbepoetin along with the transfusion counteract the transfusion's erythropoietic suppression?
abstract: OBJECTIVE
  Red blood cell (RBC) transfusions can suppress erythropoiesis. On this basis, RBC transfusions administered to very low birth weight (VLBW) neonates potentially render them more likely to qualify for a subsequent transfusion.
  
  
  METHODS
  We hypothesized that 'late' (>14 days after birth) RBC transfusions given to VLBW neonates result in a decrease in reticulocyte count persisting for at least 7 to 10 days. We also hypothesized that a single dose of darbepoetin given along with the transfusion would have the opposite effect, increasing the reticulocyte count for at least 7 to 10 days. To test this, we conducted a single-centered randomized trial with 20 VLBW neonates who, according to our transfusion guidelines, qualified for a late transfusion.
  
  
  RESULTS
  VLBW infants about to receive a late RBC transfusion were randomized (1:1) to also receive vs not receive (controls) a single subcutaneous dose of darbepoetin (10 μg kg(-1)). Reticulocyte counts diminished significantly in the controls (a drop of 85±62 × 10(3) μl(-1) (mean±s.d.) at 7 to 10 days), but increased significantly in the darbepoetin recipients (an increase of 177±120 × 10(3) μl(-1) at 7 to 10 days, P<0.0001). At 7 to 10 days after the transfusion, hematocrits of the controls were 8.1±4.9 points above their pre-transfusion values and of the darbepoetin group were 12.4±2.7 points above their pre-transfusion values (P=0.033).
  
  
  CONCLUSIONS
  This was a limited-scope, single-centered, randomized trial intended to pilot-test a new concept in neonatal transfusion practice. Namely, we tested whether a late RBC transfusion suppressed reticulocytosis and whether a concomitant single dose of darbepoetin counteracted that suppression. Using the pilot data presented in this study, larger trials can now be designed to address meaningful clinical outcomes such as transfusion avoidance using this approach.
authors: Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA.
authors: T L
authors: TL
authors: Warwood
authors: D K
authors: DK
authors: Lambert
authors: E
authors: E
authors: Henry
authors: R D
authors: RD
authors: Christensen
mesh_terms: D000751:Anemia, Neonatal / Q000628:therapy*; D000068256:Darbepoetin alfa; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D004920:Erythropoiesis; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007279:Injections, Subcutaneous; D017701:Reticulocyte Count
chemical_list: D004921:Erythropoietin; D000068256:Darbepoetin alfa