Pharmacodynamically optimized erythropoietin treatment combined with phlebotomy reduction predicted to eliminate blood transfusions in selected preterm infants.
BACKGROUND
Preterm very-low-birth-weight (VLBW) infants weighing <1.5 kg at birth develop anemia, often requiring multiple red blood cell transfusions (RBCTx). Because laboratory blood loss is a primary cause of anemia leading to RBCTx in VLBW infants, our purpose was to simulate the extent to which RBCTx can be reduced or eliminated by reducing laboratory blood loss in combination with pharmacodynamically optimized erythropoietin (Epo) treatment.


METHODS
Twenty-six VLBW ventilated infants receiving RBCTx were studied during the first month of life. RBCTx simulations were based on previously published RBCTx criteria and data-driven Epo pharmacodynamic optimization of literature-derived RBC life span and blood volume data corrected for phlebotomy loss.


RESULTS
Simulated pharmacodynamic optimization of Epo administration and reduction in phlebotomy by ≥ 55% predicted a complete elimination of RBCTx in 1.0-1.5 kg infants. In infants <1.0 kg with 100% reduction in simulated phlebotomy and optimized Epo administration, a 45% reduction in RBCTx was predicted. The mean blood volume drawn from all infants was 63 ml/kg: 33% required for analysis and 67% discarded.


CONCLUSIONS
When reduced laboratory blood loss and optimized Epo treatment are combined, marked reductions in RBCTx in ventilated VLBW infants were predicted, particularly among those with birth weights >1.0 kg.
AbbVie, North Chicago, Illinois.
Matthew R
MR
Rosebraugh
Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, Iowa.
John A
JA
Widness
Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, Iowa.
Demet
D
Nalbant
Department of Pediatrics, College of Medicine, University of Iowa, Iowa City, Iowa.
Gretchen
G
Cress
Department of Pharmaceutics, College of Pharmacy, University of Iowa, Iowa City, Iowa.
Peter
P
Veng-Pedersen
D000740:Anemia / Q000097:blood / Q000517:prevention & control; D001724:Birth Weight; D001810:Blood Volume; D003198:Computer Simulation; D017707:Erythrocyte Transfusion / Q000379:methods*; D004921:Erythropoietin / Q000097:blood / Q000494:pharmacology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D018962:Phlebotomy; D013997:Time Factors; D065227:Transfusion Reaction
D004921:Erythropoietin