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Very low birth weight infants qualifying for a ‘late’ erythrocyte transfusion: Does giving darbepoetin along with the transfusion counteract the transfusion's erythropoietic suppression?

Journal of Perinatology volume 31, pages S17–S21 (2011)Cite this article

Subjects

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.

Study Design:

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.

Result:

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 × 103 μl−1 (mean±s.d.) at 7 to 10 days), but increased significantly in the darbepoetin recipients (an increase of 177±120 × 103 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).

Conclusion:

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.

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Acknowledgements

We thank Nancy Schmutz, RN, for her assistance with the Institutional Review Board application, and Scott Scoffield, PharmD, of the Pharmacy Department and the NICU nursing staff at the McKay-Dee Hospital Center for their valuable assistance in conducting this study.

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Authors and Affiliations

  1. Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA

    T L Warwood, D K Lambert, E Henry & R D Christensen

  2. The McKay-Dee Hospital Center, Ogden, UT, USA

    T L Warwood, D K Lambert, E Henry & R D Christensen

  3. The Institute for Healthcare Delivery Research, Salt Lake City, UT, USA

    T L Warwood, D K Lambert, E Henry & R D Christensen

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  1. T L Warwood
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  2. D K Lambert
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Correspondence to R D Christensen.

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Warwood, T., Lambert, D., Henry, E. et al. Very low birth weight infants qualifying for a ‘late’ erythrocyte transfusion: Does giving darbepoetin along with the transfusion counteract the transfusion's erythropoietic suppression?. J Perinatol 31 (Suppl 1), S17–S21 (2011). https://doi.org/10.1038/jp.2010.165

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