Zuppa Antonio Alberto, Alighieri Giovanni, Calabrese Valentina, Visintini Federica, Cota Francesco, Carducci Chiara, Antichi Eleonora, Noia Giuseppe Antonio, Fortunato Giuseppe, Romagnoli Costantino
Division of Neonatalogy, Department of Pediatrics, Catholic University of the Sacred Heart, Rome, Italy.
J Pediatr Hematol Oncol. 2010 Apr;32(3):e95-101. doi: 10.1097/MPH.0b013e3181cf444c.
The majority of neonates with Rh-isoimmunization develops late anemia between the second and the sixth week of life. We report the effectiveness of recombinant human erythropoietin (rHuEPO) in preventing late anemia in 25 intrauterine and nonintrauterine-transfused neonates. The neonates were treated from 11+/-4 days after birth to 26+/-14 days (400 U/kg/d of rHuEpo, administered subcutaneously). During rHuEpo therapy, vitamin E, calcium folinate, and iron maltose were administered intramuscularly on a daily basis. Hematocrit, platelet, and neutrophil counts did not differ significantly before and after 21-days therapy. However, average values for reticulocyte showed a significant increase. The hematocrit values in the non-intrauterine transfusion (IUT) group increased progressively from the beginning to the end of the treatment, whereas that in the IUT group remained stable. Reticulocyte count increased during treatment in both groups, but it was significantly elevated in the non-IUT group only. Moreover, we observed that only neonates transfused with IUTs needed transfusions before and after treatment. This study suggests the effectiveness of rHuEpo therapy in the treatment of neonates with Rh-isoimmunization and it highlights how IUTs decrease the neonatal response efficacy. Larger, better if multicentric, randomized controlled trial are needed to definitely state whether rHuEPO safely decreases the incidence of late onset anemia.
大多数患有Rh血型免疫的新生儿在出生后第二至六周会出现晚期贫血。我们报告了重组人促红细胞生成素（rHuEPO）对25例宫内输血和非宫内输血新生儿预防晚期贫血的有效性。这些新生儿在出生后11±4天至26±14天接受治疗（rHuEpo剂量为400 U/kg/d，皮下注射）。在rHuEPO治疗期间，每天肌肉注射维生素E、亚叶酸钙和麦芽糖铁。治疗21天后，血细胞比容、血小板和中性粒细胞计数无显著差异。然而，网织红细胞的平均值显著增加。非宫内输血（IUT）组的血细胞比容值在治疗开始至结束时逐渐升高，而IUT组则保持稳定。两组治疗期间网织红细胞计数均增加，但仅非IUT组显著升高。此外，我们观察到只有接受IUT输血的新生儿在治疗前后需要输血。这项研究表明rHuEPO治疗对Rh血型免疫新生儿有效，并强调了IUT如何降低新生儿的反应疗效。需要进行更大规模、多中心随机对照试验（若能多中心则更好）来明确rHuEPO是否能安全降低晚期贫血的发生率。
