Anemia of prematurity is characterized by reduced bone marrow erythropoietic activity and low serum erythropoietin (EPO) levels. It may be compounded by folic acid, vitamin E, and iron availability and frequent blood sampling.
The low hemoglobin concentration is due to:
• Decreased red cell production (Premature infants have low EPO levels and are less responsive to EPO.)
• Shorter red cell life span
• Increased blood volume with growth.
The nadir of the hemoglobin level is 4-8 weeks and is 7 g/dL. Treatment
Recombinant human erythropoietin (rHuEPO) corrects anemia of prematurity. The dose is 75-300 units/kg/week subcutaneously for 4 weeks starting at 3-4 weeks of age. This treatment is safe, inexpensive, and effective in reducing the number of transfusions required. It takes about 2 weeks to raise the hemoglobin to a biologically significant degree, which limits its usefulness when a prompt response is needed.
Supplemental oral iron in a dose of at least 2 mg/kg/day is also required to prevent the development of iron deficiency.
The criteria for transfusion of preterm infants vary considerably among different institutions. Table 2-5 gives indications for small-volume red cell transfusions in preterm infants.
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