Shannon K M
Department of Pediatrics, Naval Hospital, Oakland, CA 94627.
Pediatr Ann. 1990 Mar;19(3):197-206. doi: 10.3928/0090-4481-19900301-07.
Recombinant human erythropoietin represents a potential therapeutic alternative to red blood cell transfusions in a number of pediatric anemias. It is effective in correcting anemia associated with chronic renal failure and may significantly reduce the morbidity associated with childhood CRF. Most exposures to allogeneic blood products in pediatrics for treatment of anemia with blood transfusions occur in neonatal intensive care units. If proven effective in treating anemia in premature babies, r-HuEPO will be responsible for a major reduction in the use of blood transfusions in clinical neonatology. Carefully designed, placebo-controlled clinical trials will be required to establish the role of r-HuEPO in anemia of prematurity. Recombinant human erythropoietin also may be useful to increase the amount of blood that can be collected before elective surgical procedures. Another potential indication is to raise the hematocrits of infants with large intracardiac shunts who develop congestive heart failure coincident with the developmental fall in hemoglobin concentration after birth. Finally, r-HuEPO may one day play a role in modifying the expression of globin genes and, thereby, ameliorate the course of sickle cell disease and beta thalassemia. Many questions surrounding the use of r-HuEPO in infancy and childhood are being addressed in ongoing clinical trials.
重组人促红细胞生成素在多种小儿贫血症中是红细胞输血的一种潜在治疗替代方法。它在纠正与慢性肾衰竭相关的贫血方面有效，并且可能显著降低与儿童慢性肾衰竭相关的发病率。儿科中大多数因输血治疗贫血而接触异体血制品的情况发生在新生儿重症监护病房。如果证明对治疗早产儿贫血有效，重组人促红细胞生成素将大大减少临床新生儿学中输血的使用。需要精心设计的、安慰剂对照的临床试验来确定重组人促红细胞生成素在早产儿贫血中的作用。重组人促红细胞生成素也可能有助于增加择期手术前可采集的血量。另一个潜在适应症是提高患有大型心内分流且出生后随着血红蛋白浓度下降而出现充血性心力衰竭的婴儿的血细胞比容。最后，重组人促红细胞生成素可能有一天会在改变珠蛋白基因表达方面发挥作用，从而改善镰状细胞病和β地中海贫血的病程。正在进行的临床试验正在解决围绕重组人促红细胞生成素在婴儿期和儿童期使用的许多问题。
