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Iron supplementation enhances response to high doses of recombinant human erythropoietin in preterm infants
  1. Virgilio P Carnielli,
  2. Rosalia Da Riol,
  3. Giovanni Montini
  1. Department of Paediatrics University of Padova Via Giustiniani 3 35128 Padova Italy
  1. Dr Virgilio P Carnielli. Email: carnielli{at}


AIMS To determine whether iron supplementation would enhance erythropoiesis in preterm infants treated with high doses of human recombinant erythropoietin (r-HuEPO).

METHODS Sixty three preterm infants were randomly allocated at birth to one of three groups to receive: r-HuEPO alone, 1200 IU/kg/week (EPO); or r-HuEPO and iron, 1200 IU/kg/week of r-HuEPO plus 20 mg/kg/week of intravenous iron (EPO+iron); or to serve as controls. All three groups received blood transfusions according to uniform guidelines.

RESULTS Infants in the EPO+iron group needed fewer transfusions than controls—mean (95% CI) 1.0 (0.28–1.18) vs 2.9 (1.84–3.88) and received lower volumes of blood—mean (95% CI) 16.7 (4.9–28.6)vs 44.4 (29.0–59.7) ml/kg. The EPO group also needed lower volumes of blood than the controls—mean (95% CI) 20.1 (6.2–34.2) vs 44.4 (29.0–59.7) ml/kg, but the same number of transfusions, 1.3 (0.54–2.06)vs 2.9 (1.84–3.88). Reticulocyte and haematocrit values from postnatal weeks 5 to 8 were higher in the EPO+iron than in the EPO group, and both groups had higher values than the controls. Mean (SEM) plasma ferritin was lower in the EPO group—65 (55) μg/l than in the EPO+iron group 780 (182) μg/l, and 561 (228) μg/l in the control infants.

CONCLUSIONS Early administration of high doses of r-HuEPO with iron supplements significantly reduced the need for blood transfusion. Intravenous iron (20 mg/kg/week in conjunction with r-HuEPO yielded a higher reticulocyte count and haematocrit concentration after the forth week of life than r-HuEPO alone. Infants treated with r-HuEPO alone showed signs of reduced iron stores.

  • erythropoietin
  • anaemia of prematurity
  • transfusion
  • iron supplementation

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