Anemia of prematurity medical therapy: Difference between revisions
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{{Anemia of prematurity}} | {{Anemia of prematurity}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{Asra}} | ||
==Overview== | ==Overview== | ||
[[Blood transfusion]] is the mainstay in the [[treatments|treatment]] of [[anemia of prematurity]]. [[Treatments|Treatment]] of [[infant|infants]] with [[anemia of prematurity]] depends on the severity of [[symptom|symptoms]]. [[Asymptomatic]] [[patient|patients]] are managed with [[close monitoring]] and [[supportive care]]. Whereas, [[blood transfusion]] and [[recombinant]] [[erythropoietin]] [[therapy]] are required to [[treat]] [[infant|infants]] with symptomatic [[anemia of prematurity]]. | |||
==Medical therapy== | ==Medical therapy== | ||
The optimal therapy for [[anemia of prematurity]] depends on the severity of [[symptoms]]. Patients with [[asymptomatic]] [[anemia of prematurity]] require [[observation]] and [[supportive care]], whereas [[symptomatic]] patients are treated either with [[blood transfusion]] or [[recombinant]] [[erythropoietin]] [[(EPO)]] [[therapy]]. <ref>{{cite web |url=https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/pediatrics/anemia-of-prematurity/#:~:text=Anemia%20of%20prematurity%20is%20a,cell%20transfusions%20to%20replace%20loss. |title=www.cancertherapyadvisor.com |format= |work= |accessdate=}}</ref> | The optimal therapy for [[anemia of prematurity]] depends on the severity of [[symptoms]]. Patients with [[asymptomatic]] [[anemia of prematurity]] require [[observation]] and [[supportive care]], whereas [[symptomatic]] patients are treated either with [[blood transfusion]] or [[recombinant]] [[erythropoietin]] [[(EPO)]] [[therapy]]. <ref>{{cite web |url=https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/pediatrics/anemia-of-prematurity/#:~:text=Anemia%20of%20prematurity%20is%20a,cell%20transfusions%20to%20replace%20loss. |title=www.cancertherapyadvisor.com |format= |work= |accessdate=}}</ref> | ||
===Asymptomatic patients=== | ===Asymptomatic patients=== | ||
*Patients with no [[symptoms]], stable [[vital signs]] and adequate [[nutrition]] require no [[treatment]] | *[[Patient|Patients]] with no [[symptom|symptoms]], stable [[vital signs]], and adequate [[nutrition]] require no [[treatments|treatment]] | ||
*[[Close monitoring]] and [[supportive care]] | *[[Close monitoring]] and [[supportive care]] are the preferred management in [[asymptomatic]] [[infant|infants]] with [[anemia of prematurity]] | ||
*Measures should be taken to maintain adequate levels of [[ | *Measures should be taken to maintain adequate levels of [[vitamin E]], [[vitamin B12]], [[vitamin B6]], and [[iron]] | ||
*Regular checking of [[hematocrit]] is essential in [[infants]] with [[anemia of prematurity]] until a steady increase in the [[hematocrit]] levels has been achieved | *Regular checking of [[hematocrit]] is essential in [[infant|infants]] with [[anemia of prematurity]] until a steady increase in the [[hematocrit]] levels has been achieved | ||
===Symptomatic patients=== | ===Symptomatic patients=== | ||
[[Blood transfusion]] is the mainstay in the [[treatment]] of [[infants]] with [[symptomatic]] [[anemia of prematurity]]. [[Exogenous]] [[recombinant]] human [[erythropoietin]] can also be used. | [[Blood transfusion]] is the mainstay in the [[treatments|treatment]] of [[infant|infants]] with [[symptomatic]] [[anemia of prematurity]]. [[Exogenous]] [[recombinant]] human [[erythropoietin]] can also be used.<ref name="pmid20817366">{{cite journal| author=Strauss RG| title=Anaemia of prematurity: pathophysiology and treatment. | journal=Blood Rev | year= 2010 | volume= 24 | issue= 6 | pages= 221-5 | pmid=20817366 | doi=10.1016/j.blre.2010.08.001 | pmc=2981681 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20817366 }} </ref><ref>{{cite web |url=https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/pediatrics/anemia-of-prematurity/#:~:text=Anemia%20of%20prematurity%20is%20a,cell%20transfusions%20to%20replace%20loss. |title=www.cancertherapyadvisor.com |format= |work= |accessdate=}}</ref> | ||
====Erythropoietin==== | ====Erythropoietin==== | ||
*[[Erythropoietin]] (EPO) helps in preventing [[anemia of prematurity]] in [[preterm]] and [[low birth weight]] [[infants]] | *[[Erythropoietin]] (EPO) helps in preventing [[anemia of prematurity]] in [[preterm]] and [[low birth weight]] [[infants]] | ||
*Alternatively, [[Darbepoietin | *[[Recombinant]] human [[erythropoietin]] is used in [[premature infants]] to decrease the number of [[complication|complications]] associated with the [[transfusion therapy]] | ||
*The preferred [[route of administration]] is the [[subcutaneous]] route | |||
*The preferred [[regimen]] is 400U/kg/dose through the [[subcutaneous]] route (SC) 3 times a week or 200U/kg/dose through the [[intravenous]] (IV) route daily | |||
*[[Preterm]] [[infant|infants]] respond well to [[erythropoietin]] (EPO) therapy with [[reticulocytosis]] | |||
*[[Iron]] and [[folic acid]] supplementation is essential | |||
*The preferred regimen for [[iron]] supplementation is 6-8 mg/kg/day orally or 1 mg/kg IV of [[iron sucrose]] or [[iron dextran]] | |||
*Regular monitoring of [[serum iron]] levels should be done using serum [[ferritin]] or [[zinc protoporphyrin to heme ratio]], monthly or bimonthly | |||
*Although no adverse effects have been documented in the [[newborns]], [[erythropoietin]] therapy is not universally accepted as the standard [[therapy]] for [[infants]] with [[anemia of prematurity]] | |||
*Alternatively, [[Darbepoietin alfa]] can also be used | |||
=====Complications===== | |||
[[Complication|Complications]] associated with [[erythropoietin]] [[therapy]] are minimal in [[premature|preterm]] [[infant|infants]]. Following [[complication|complications]] have been documented in [[adults|adult]] [[patient|patients]] treated with recombinant [[erythropoietin]] [[therapy]]. | |||
*[[Polycythemia]] | |||
*[[Venous thromboembolism]] | |||
*[[Hypertension]] | |||
*[[Stroke]] | |||
*[[Seizure|Seizures]] | |||
*Immune-mediated [[anemia]] | |||
*Unexpected [[death]] | |||
====Blood Transfusion==== | ====Blood Transfusion==== | ||
*[[Transfusion therapy]] is the mainstay in the [[treatment]] of [[anemia of prematurity]] | *[[Transfusion therapy]] is the mainstay in the [[treatments|treatment]] of [[anemia of prematurity]] | ||
*Frequency of [[transfusions]] depends on the [[gestational age]] and [[ | *Frequency of [[transfusion|transfusions]] depends on the [[gestational age]] and severity of [[symptom|symptoms]] | ||
*A transient decrease in | *A transient decrease in [[erythropoiesis]] and [[erythropoietin]] levels occur after the [[blood transfusion]] | ||
*[[PRBC transfusion]] results in an increase in [[systemic]] [[oxygen transport]] and decrease in [[lactic acid]] levels, [[cardiac output]], and fractional [[oxygen]] extraction | *[[PRBC transfusion]] results in an increase in [[systemic]] [[oxygen transport]] and decrease in [[lactic acid]] levels, [[cardiac output]], and fractional [[oxygen]] extraction | ||
*Significant [[infectious]], [[hematologic]], [[immunologic]], [[metabolic]] [[complications]] are associated with [[blood transfusion]] in [[infants]] so [[standard protocols]] should be followed | *[[Transfusion guidelines]] that should be followed in [[infant|infants]] with [[anemia of prematurity]] are | ||
**15-20 mg/kg of [[PRBC]] transfused over 3-4 hours | |||
**[[Irradiated]], [[CMV]] negative, [[leukocyte]] depleted, [[hemoglobin S]] negative, typed and screened [[PRBC]] should be used for [[transfusions|transfusion]] | |||
**[[Infant|Infants]] with [[anemia of prematurity]] are given [[blood transfusion]] if: | |||
***[[Hematocrit]] is less than 35% in first week after [[birth]] and [[infant]] is unstable | |||
***[[Hematocrit]] is less than 28% in first week after [[birth]] or [[infant]] is unstable | |||
***[[Hematocrit]] is less than 20% after one week of [[birth]] | |||
=====Complications===== | |||
Significant [[infectious]], [[hematologic]], [[immunologic]], [[metabolic]] [[complication|complications]] are associated with [[blood transfusion]] in [[infant|infants]] so [[standard protocols]] should be followed. [[Complication|Complications]] associated with [[blood transfusion]] are: | |||
*[[Allergic reactions]] | |||
*[[Infections]] | |||
*[[Fluid overload]] | |||
*[[Calcium]] disturbance | |||
*[[Electrolyte imbalance]] | |||
*[[Iron overload]] | |||
*[[Necrotizing enterocolitis]] | |||
*[[Bronchopulmonary dysplasia]] | |||
*[[Immune mediated]] adverse reactions | |||
**[[Acute hemolytic reaction]] | |||
**[[Febrile non-hemolytic transfuion reaction]] | |||
**[[Transfusion-related acute lung injury]] | |||
**[[Graft versus host disease]] | |||
**[[Immunosuppression]] | |||
*[[Transfusion]] of [[toxic substances]] present in the blood | |||
**[[Lead]] | |||
**[[Mercury]] | |||
**[[Plasticizers]] | |||
==References== | ==References== | ||
Latest revision as of 16:30, 9 August 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Asra Firdous, M.B.B.S.[2]
Overview
Blood transfusion is the mainstay in the treatment of anemia of prematurity. Treatment of infants with anemia of prematurity depends on the severity of symptoms. Asymptomatic patients are managed with close monitoring and supportive care. Whereas, blood transfusion and recombinant erythropoietin therapy are required to treat infants with symptomatic anemia of prematurity.
Medical therapy
The optimal therapy for anemia of prematurity depends on the severity of symptoms. Patients with asymptomatic anemia of prematurity require observation and supportive care, whereas symptomatic patients are treated either with blood transfusion or recombinant erythropoietin (EPO) therapy. [1]
Asymptomatic patients
- Patients with no symptoms, stable vital signs, and adequate nutrition require no treatment
- Close monitoring and supportive care are the preferred management in asymptomatic infants with anemia of prematurity
- Measures should be taken to maintain adequate levels of vitamin E, vitamin B12, vitamin B6, and iron
- Regular checking of hematocrit is essential in infants with anemia of prematurity until a steady increase in the hematocrit levels has been achieved
Symptomatic patients
Blood transfusion is the mainstay in the treatment of infants with symptomatic anemia of prematurity. Exogenous recombinant human erythropoietin can also be used.[2][3]
Erythropoietin
- Erythropoietin (EPO) helps in preventing anemia of prematurity in preterm and low birth weight infants
- Recombinant human erythropoietin is used in premature infants to decrease the number of complications associated with the transfusion therapy
- The preferred route of administration is the subcutaneous route
- The preferred regimen is 400U/kg/dose through the subcutaneous route (SC) 3 times a week or 200U/kg/dose through the intravenous (IV) route daily
- Preterm infants respond well to erythropoietin (EPO) therapy with reticulocytosis
- Iron and folic acid supplementation is essential
- The preferred regimen for iron supplementation is 6-8 mg/kg/day orally or 1 mg/kg IV of iron sucrose or iron dextran
- Regular monitoring of serum iron levels should be done using serum ferritin or zinc protoporphyrin to heme ratio, monthly or bimonthly
- Although no adverse effects have been documented in the newborns, erythropoietin therapy is not universally accepted as the standard therapy for infants with anemia of prematurity
- Alternatively, Darbepoietin alfa can also be used
Complications
Complications associated with erythropoietin therapy are minimal in preterm infants. Following complications have been documented in adult patients treated with recombinant erythropoietin therapy.
- Polycythemia
- Venous thromboembolism
- Hypertension
- Stroke
- Seizures
- Immune-mediated anemia
- Unexpected death
Blood Transfusion
- Transfusion therapy is the mainstay in the treatment of anemia of prematurity
- Frequency of transfusions depends on the gestational age and severity of symptoms
- A transient decrease in erythropoiesis and erythropoietin levels occur after the blood transfusion
- PRBC transfusion results in an increase in systemic oxygen transport and decrease in lactic acid levels, cardiac output, and fractional oxygen extraction
- Transfusion guidelines that should be followed in infants with anemia of prematurity are
- 15-20 mg/kg of PRBC transfused over 3-4 hours
- Irradiated, CMV negative, leukocyte depleted, hemoglobin S negative, typed and screened PRBC should be used for transfusion
- Infants with anemia of prematurity are given blood transfusion if:
- Hematocrit is less than 35% in first week after birth and infant is unstable
- Hematocrit is less than 28% in first week after birth or infant is unstable
- Hematocrit is less than 20% after one week of birth
Complications
Significant infectious, hematologic, immunologic, metabolic complications are associated with blood transfusion in infants so standard protocols should be followed. Complications associated with blood transfusion are:
- Allergic reactions
- Infections
- Fluid overload
- Calcium disturbance
- Electrolyte imbalance
- Iron overload
- Necrotizing enterocolitis
- Bronchopulmonary dysplasia
- Immune mediated adverse reactions
- Transfusion of toxic substances present in the blood
References
- ↑ "www.cancertherapyadvisor.com".
- ↑ Strauss RG (2010). "Anaemia of prematurity: pathophysiology and treatment". Blood Rev. 24 (6): 221–5. doi:10.1016/j.blre.2010.08.001. PMC 2981681. PMID 20817366.
- ↑ "www.cancertherapyadvisor.com".