Anemia of prematurity medical therapy: Difference between revisions

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{{Anemia of prematurity}}
{{Anemia of prematurity}}


{{CMG}}
{{CMG}}; {{AE}} {{Asra}}


==Overview==
==Overview==
==Medical Therapy==
[[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]].
The best treatment is prevention by minimizing the amount of blood drawn from the infant. Modern technology, including non-invasive pulse-oximetry, development of laboratory equipment that can use very small blood volume samples, and in-dwelling monitors that can measure blood-gas parameters without removing any blood have helped delay or even eliminate anemia of prematurity in some infants.


Recombinant EPO may be given to premature infants to stimulate red blood cell production. Premature infants are equally responsive to EPO as term infants.  However, the response to EPO typically takes up to 2 weeks.  To date, studies of EPO use in premature infants have had mixed results. It is likely that only a carefully selected subpopulation of infants may benefit from its use.
==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>
 
===Asymptomatic patients===
*[[Patient|Patients]] with no [[symptom|symptoms]], stable [[vital signs]], and adequate [[nutrition]] require no [[treatments|treatment]]
*[[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 [[vitamin E]], [[vitamin B12]], [[vitamin B6]], and [[iron]]
*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===
[[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]] (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 [[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====
*[[Transfusion therapy]] is the mainstay in the [[treatments|treatment]] of [[anemia of prematurity]]
*Frequency of [[transfusion|transfusions]] depends on the [[gestational age]] and severity of [[symptom|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 [[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]]


Treatment of symptomatic anemia of prematurity is with blood transfusion.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

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

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

Complications

Complications associated with erythropoietin therapy are minimal in preterm infants. Following complications have been documented in adult patients treated with recombinant erythropoietin therapy.

Blood Transfusion

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:

References

  1. ↑ "www.cancertherapyadvisor.com".
  2. ↑ 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.
  3. ↑ "www.cancertherapyadvisor.com".

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