March 1995

Epoetin Alfa Therapy in Infants Awaiting Heart Transplantation

Author Affiliations

From the Department of Pediatrics, Primary Children's Medical Center and the University of Utah, and the UTAH Cardiac Transplant Program, Salt Lake City.

Arch Pediatr Adolesc Med. 1995;149(3):322-325. doi:10.1001/archpedi.1995.02170150102020

Objective:  To determine the safety and efficacy of epoetin alfa therapy in infants awaiting heart transplantation to minimize the need for blood transfusions.

Design:  Prospective case series analysis.

Setting:  Pediatric tertiary care center.

Patients:  Eleven term infants (4 to 54 days old) awaiting heart transplantation.

Intervention:  Infants received 16 courses of daily epoetin therapy and four subsequent courses of alternate-day epoetin therapy.

Results:  Daily epoetin therapy was instituted at 23.6±4.5 days of age, and the duration of treatment was 13.8±3.9 days (mean±SEM). During daily epoetin therapy, the hematocrit increased from 0.42±0.015 to 0.50±0.019 (P<.001), and the reticulocyte count increased from 58±9×10−3 to 105±16×10−3(P<.05). There were no significant changes in leukocyte count (13.4±1.0× 109/L vs 15.1±0.9×109/L), platelet count (402±43×109/L vs 387±39×109/L), or creatinine (53±9 μmol/L [0.6±0.1 mg/dL] vs 53±9 μmol/L [0.6±0.1 mg/dL]) (not significant). Four patients received blood transfusions during daily epoetin therapy, but the amount of blood administered to patients was significantly less (0.9±0.5 mL/kg per day) than the phlebotomy losses (1.8±0.4 mL/kg per day) (P<.01). During alternate-day epoetin therapy, the hematocrit decreased from 0.53±0.014 to 0.43±0.019 (P<.05).

Conclusions:  Daily epoetin therapy appears to be effective in maintaining stable hematocrit in infants awaiting heart transplantation, who generally require multiple transfusions secondary to iatrogenic blood losses.(Arch Pediatr Adolesc Med. 1995;149:322-325)