The management of (Rhesus) hemolytic disease of the fetus and newborn includes
intrauterine transfusions to prevent the development of
hydrops, treatment of the possible
hyperbilirubinemia in the immediate postnatal period, and treatment of late
anemia. Low levels of serum
erythropoietin due to suppression of the bone marrow by multiple
intrauterine transfusions is a suggested mechanism for this
anemia. The aim of our study was to test whether recombinant human
erythropoietin reduced the need for
erythrocyte transfusions in these infants. Twenty infants with Rhesus isoimmunization were blindly randomized to treatment and control groups at the 2nd wk of life. The number of intrauterine and exchange transfusions and demographic data were similar in both groups. The infants in the treatment group received recombinant human
erythropoietin, s.c. 200 U/kg of
body weight three times a week for a period of 6 wk, whereas the infants in the control group received a placebo for the same period. In the treatment group, the mean number of
erythrocyte transfusions was significantly lower than that of the control group (1.8 versus 4.2). The reticulocyte counts and Hb levels rose earlier in the treatment group. The platelet and neutrophil counts were similar in both groups throughout the study. This study demonstrates that recombinant human
erythropoietin treatment decreases the need for
erythrocyte transfusions in the late
anemia of infants with Rh isoimmunization. Considering the risks of
blood transfusions, this decrease in the donor exposure is worthwhile.