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Anemia of prematurity


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Anemia of prematurity

  2. 2. INTRODUCTION. • Erythropoiesis decreases after birth. • Because of increased tissue oxygenation.
  3. 3. • In term infants, the hemoglobin level typically reaches an average nadir of 11 g/dL at approximately 8 to 12 weeks after birth.
  4. 4. PATHOGENESIS. • Primary cause of anemia of prematurity (AOP) is the impaired ability to increase serum erythropoietin (EPO).
  5. 5. • EPO is produced by the fetal liver and the cortical interstitial cells of the kidney in response to hypoxia. • Liver is the principal site of EPO production in the fetus.
  6. 6. Other factors for AOP. • Blood loss from phlebotomy. • Reduced red blood cell life span. • Iron depletion.
  7. 7. Blood loss from phlebotomy. • Iatrogenic blood loss due to phlebotomy for blood tests. • Laboratory studies contributed to iatrogenic blood loss by 2 to 4 mL/kg per week.
  8. 8. Reduced red blood cell life span. • Term infants is approximately 60 to 80 days. • Range of 45 to 50 days in extremely low birth weight infants (ELBW). • Reduced red cell life span contributes to the severity of anemia.
  9. 9. Iron depletion. • Iron depletion may impair recovery from AOP. • Because of their rapid growth rate, premature infants have increased utilization and depletion of iron stores. • Administration of iron does not inhibit the fall in hemoglobin concentration due to AOP.
  10. 10. CLINICAL AND LABORATORY FEATURES. • Typically occurs at 3 to 12 weeks after birth. • Onset of AOP is inversely proportional to the gestational age at birth. • Anemia typically resolves by three to six months of age.
  11. 11. Laboratory findings. • Anemia. • Normocytic and normochromic red blood cells. • Reticulocyte count is low, and red blood cell precursors in the bone marrow are decreased. • Serum concentrations of EPO are low.
  12. 12. MANAGEMENT. • Optimal nutrition (Iron supplementation). • Red blood cell transfusions are primarily.
  13. 13. Iron supplementation. • Iron stores depleted by two to three months of age. • As a result, all preterm infants should receive iron supplementation of 2 to 4 mg/kg per day through the first year of life.
  14. 14. Transfusion. • RBC transfusion is the most rapidly effective treatment for AOP. • Transfusion is a temporary measure. • Performed when the level of anemia becomes symptomatic.
  15. 15. Erythropoietin. • Pathogenetic importance of impaired EPO production in AOP provides the rationale for the therapy with recombinant human EPO. • Approach has not been accepted widely because it appears to have limited efficacy in decreasing the number of blood donors to which the infant is exposed via transfusion.
  16. 16. Complications. • Use of EPO in premature infants appears to be safe. • Complications include the following: • Transient neutropenia that resolves with cessation of therapy. • Iron deficiency occurs if supplementation is inadequate.
  17. 17. Dose. • Administered intravenously (200 U/kg per dose once daily) or subcutaneously (400 U/kg per dose, 3 times per week). • Infants treated with EPO require iron supplementation.
  18. 18. SUMMARY AND RECOMMENDATIONS. • Newborn infants have a fall in hematocrit soon after birth due primarily to impaired production of erythropoietin. • Preterm infants, the decline occurs earlier, is more pronounced, and is called anemia of prematurity (AOP). • AOP typically occurs at 3 to 12 weeks.
  19. 19. • Laboratory findings characteristic of AOP include normocytic and normochromic red blood cells, low reticulocyte count, and low erythropoietin levels. • AOP may require treatment with RBCs transfusion. • Transfusion is a temporary.
  20. 20. • Administration of recombinant human erythropoietin (EPO) appears to have limited efficacy. • We recommend NOT to routinely administer EPO to preterm infants.
  21. 21. THANKS.