IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE?

Ayla Günlemez

Research Article

IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE?

Year 2001, Volume: 54 Issue: 3, 187 - 193, 30.09.2001

Abstract

Serum transferrin receptor (sTfR) levels reflect both iron need and the rate of erythropoiesis. The objective of this study was to investigate iron requirements in simultaneously transfused very low birth weight (VLBW) preterms when erythropoiesis is stimulated by standard doses of human recombinant erytropoietin (rHuEPO). included in the study were 23 VLBW infants. All of the infants received rHuEPO 200 IU/kg subcutaneously three times a week, starting by the end of the Ist week and continuing until the end of the 7th
week. Fourteen of the infants were randomly selected to be supplemented with 3mg/kg/day of iron at the start of rHuEPO therapy (Group 1). In the remaining nine infants, iron supplementation began after the end of the 6th week or when serum ferritin concentrations fell below 150 ng/ml (Group Ii). All of the infants were
transfused according to the same transfusion policy. Haematocrit, reticulocyte, ferritin and sTfR levels were evaluated and compared at the beginning, during, and at the end of the study. Baseline parameters were similar in both groups. Haematocrit concentrations remained similar during and at the end of the study. Serum ferritin
level was higher in Group | than in Group Il during (day 28) and at the end of the study (day 42), but the differences were not significant (422.78(122.98 versus 227(33.47 and 204.5(61 versus 111.2(16.4 mg/dl, respectively). STIR concentrations were higher in Group | than in Group il during the study (Days 14 and 28) but lower at the end (Day 42) of the study, but the differences were again not significant (53.87( 22.38 versus 23.17(1.09 on Day 14; 46.3(14.27 versus 24.84(2.66 on Day 28; and 26.1(3.01 versus
34.21(3.36 on Day 42, respectively). Reticulocyte counts in Group | were significantly higher than in Group Il at the end of the study (6.1 (0.6 versus 2.9 (0.5; p=0.006). Serum ferritin levels are high and remain stably high during rHuEPO treatment in VLBW infants, if they are transfused heavily, due to large volumes of phlebotomy during clinical follow-up; thus,
the timing and dose of iron supplementation is questionable in this group. Erytropoiesis and iron need is slightly better met when iron supplementation is started simultaneously with rHuEPO, STIR levels re unpredictable, as the preterms were given heavy transfusions,

Keywords

Anemia of Prematurity , Erythropoietin , iron , Serum , ransferrin Receptor.

Supporting Institution

Project Number

Thanks

References

1. Arsan S, Ecevit A, Tarcan A, et al. Recombinant human erytropoietin therapy in very low birth weight infants (abstract). XIVth Meeting of the International Society of Haematology, Europian and African Division Stockholm, Sweeden, Aug 30-Sept 4,1997; Abstract Book pp:20.
2. Asch J, Wedgewood JF. Optimizing the approach to anemia in preterm infants. J Perinatol 1997; 17: 276-82.
3. Kumar P, Shankaran S, Krishnan RG. Recombinant human erytropoietin therapy for treatment of anemia prematurity in very low birth weight infants: A randomised, double blind, placebo controlled trial. J Perinatol 1998; 18: 173-177.
4. Messer J, Haddad J, Donato L, Astruct D, Matis J. Early tratment of premature infants with recombinant human erytropoietin. Pediatrics 1993; 92:519-523.
5. Kiviviori SM, Heikinheimo M, Teppo A, et al. Early rise in serum concentration of transferrin receptor induced by human recombinant erytropoietin in very low birth weight infants. PediatrR 1994; 36: 85-89.
6. Ehrenkranz RA, Sherwonit EA, Nelli CM, et al. Recombinant human erytropoietin stimulates incorporation of absorbed iron into RBC’s in VLBW infants. Pediatr Res 1994; 35: 311A.
7. Carpani G, Biscaglia M, ghisoni L, et al. Soluble transferrin receptor in the study of fetal erytropoietic activity. Am ] Hematol 1996; 52:192- 196.
8. Tarcan A, Arsan S, Ecevit A, et al. Risk factors, need for transfusion and progress of anemia of prematurity in very low birth weight infants. (abstract) X!Vth Meeting of the International Society of Haematology, Europian and African Division Stockholm, Sweeden, Aug 30-Sept 4,1997; Abstract Book pp: 207.
9. Brown MS, Keith JF. Comparison between two and five doses a week of recombinant human erytropoietin for anemia of prematurity. A randomised trial. Pediatrics 1999; 104: 210-215.
10. Meyer MP, Haworth C, Meyer JH, Commerford A. A comparison of oral and intravenous iron supplementation in preterm infants receiving recombinant human erytropoietin. J Peditr 1996; 129: 258-263.
11. Soubasi V, kremenepoulus G, Diamendi E, et al. In which neonates does recombinant human erytropoietin treatment prevent anemia of prematurity: results of a randomised controlled study. Pediatr Res 1993; 34:675-79.,
12. CarnielliV, Montini G, Da Riol R, Dall’Amico R, Cantarutti F.Decreased ferritin levels,despite iron supplementation, during erytropoietin therapy in anemia of prematurity. Acta Pediatr 1996; 85:496-501.
13. Bader D, Blondheim O, Jonas R, et al. Decreased ferritin levels, despite iron supplementation, during erytropoietin therapy in anemia of prematurity. Acta Pediatr 1996; 85. 496-501.
14, Bechensteen AG, Haga P, Halversen S, et al. Erytropoietin, protein, and iron supplementation and the prevention of anemia of prematurity. Arch Dis Child 1993; 69: 19-23.
15 Bechensteen AG, Haga P, Halversen S, et al. Effect of low and moderate doses of recombinant human erytropoietin on the haematological response in premature infants on a high protein and iron intake. Eur J Pediatr 1997;156: 56-61.
16.. Huebers HA, Beguin Y, Pootrakul P, et al. Intact transferrin receptors in human plasma and their relation to erytropoiesis. Blood 1990;75:102-. 107.
17. Macdougall IC, Cavill |, Hulme B, et al. Detection of iron deficiency during erytropoietin treatment: a new approach. BM] 1992; 304:225- 226.
18. North M, Dallalio G, Donath AS, Melink R, Means RT. Serum transferrin receptor levels in patients undergoing evaluation of iron _ stores. Correlation with other parameters and observed versus predicted results. Clin. Lab. Haem. 1997; 19:93-97,
19. Doyle JJ. The role of erytropoietin in the anemia of prematurity. Sem Perinatol 1997;21: 20-27

ÇOK DUSUK DOĞUM AĞIRLIKLI PRETEMLERIN UYARILMIŞ ERITROPOEZINDE DEMİR GEREKSINiMİ

Year 2001, Volume: 54 Issue: 3, 187 - 193, 30.09.2001

Ayla Günlemez

Abstract

Serum transferin reseptör (sTfR) konsantrasyonu eritropoez ve doku demir gereksinimini göstermektedir. Bu çalışmanın amacı; sıklıkla kan transfüzyonu uygulanan çok düşük doğum ağırIıklı pretermlerde (ÇDDA) standart doz eritropoetin (rHuEPO) tedavisi ile uyarılmış eritropoez sırasında demir gereksiniminin belirlenmesidir. Çalışmaya alınan 23 CDDA‘I: preterme 200 U/kg/doz, haftada 3 gün, subkutan postnatal 1. haftanın sonundan 7.hafta sonuna dek rHuEPO uygulandı. Grup I’i oluşturan 14 hastaya rHuEPO tedavisi ile eş zamanlı 3 mg/kg/gün dozunda demir verildi. Grup il’i oluşturan 9 hastaya ise serum ferritin dizeyleri 150 ng/ml’nin altına düştüğünde veya tedavi sonunda demir başlandı. Hastalara transfüzyon aynı kriterler göre uygulandı. Tedavi başlangıçta tedavi sırasında ve sonunda hematokrit, retikiHosit, ferritin, ve sTfR dizeyleri değerlendirildi ve gruplar karşılaştırdı. Uygulanan benzer transfüzyon politikasına bağlı olarak her iki grupta hematokrit düzeyleri tedavi sırasında ve sonunda farklı değildi. Serum ferrittin düzeyleri tedavi sırasında (28.giün) Grup Ide 441.78 (122.98 mg/ml Grup Il’de 227(33.47 mg/ml, tedavi sonunda (42.guin) Grup I’de 204.5(61 Grup I’'de 111.2(16.4 mg/ml bulundu. Gruplarin ferritin dizeyleri arasındaki fark anlamlı değildi. STFR düzeyleri Grup Ide 14.gtin, 28.giin ve tedavi sonunda sırasıyla 53.87(22.8, 46.3 ( 14.27, 26.1(3.01 nmol/L; Grupli’de ise 14.gtin, 28.guin ve tedavi sonunda sırasıyla 23.17(1.09, 24.84(2.66, 34.21( 3.36 nmol/L idi. Gruplarda günlere göre sTfR dizeyleri arasındaki fark anlamlı değildi. Tedavi sonu retikülosit değerleri Grup I’de 6.1.(0.6 iken Grup Ii’de 2.9.(0.5 bulundu. Bu fark istatistiksel olarak anlamlı idi (p=0.0006). ÇDDA‘Iı pretermlerde aneminin eritropoetin ile tedavisi sırasında flebotomi kayıplarının yerine koymak ve klinik takip icin uygulanan transfizyonlara bağlı olarak serum ferritin dizeyleri yüksektir. Bu hastalarda demir suplemantasyonunun dozu ve zamanlaması tartışılmalıdır. Eritropoetin tedavisi ile es zamanlı demir başlanan Grup I’de demir gereksiniminin biraz daha iyi karşılandığı ve ferritin dizeylerinin yüksek bulunduğu erken dönemde sTfR’nin yükselmesinin uyarılmuş eritropoezde artmış demir gereksinimine bağlı olabileceği düşünülse de yapılan çoklu transfüzyonlar nedeniyle sTfR düzeylerinin değerlendirilmesi güçtür.

Keywords

Eritropoetin , Preterm Anemisi , Serum Transferrin Resptérd , DEMİR

Project Number

References

1. Arsan S, Ecevit A, Tarcan A, et al. Recombinant human erytropoietin therapy in very low birth weight infants (abstract). XIVth Meeting of the International Society of Haematology, Europian and African Division Stockholm, Sweeden, Aug 30-Sept 4,1997; Abstract Book pp:20.
2. Asch J, Wedgewood JF. Optimizing the approach to anemia in preterm infants. J Perinatol 1997; 17: 276-82.
3. Kumar P, Shankaran S, Krishnan RG. Recombinant human erytropoietin therapy for treatment of anemia prematurity in very low birth weight infants: A randomised, double blind, placebo controlled trial. J Perinatol 1998; 18: 173-177.
4. Messer J, Haddad J, Donato L, Astruct D, Matis J. Early tratment of premature infants with recombinant human erytropoietin. Pediatrics 1993; 92:519-523.
5. Kiviviori SM, Heikinheimo M, Teppo A, et al. Early rise in serum concentration of transferrin receptor induced by human recombinant erytropoietin in very low birth weight infants. PediatrR 1994; 36: 85-89.
6. Ehrenkranz RA, Sherwonit EA, Nelli CM, et al. Recombinant human erytropoietin stimulates incorporation of absorbed iron into RBC’s in VLBW infants. Pediatr Res 1994; 35: 311A.
7. Carpani G, Biscaglia M, ghisoni L, et al. Soluble transferrin receptor in the study of fetal erytropoietic activity. Am ] Hematol 1996; 52:192- 196.
8. Tarcan A, Arsan S, Ecevit A, et al. Risk factors, need for transfusion and progress of anemia of prematurity in very low birth weight infants. (abstract) X!Vth Meeting of the International Society of Haematology, Europian and African Division Stockholm, Sweeden, Aug 30-Sept 4,1997; Abstract Book pp: 207.
9. Brown MS, Keith JF. Comparison between two and five doses a week of recombinant human erytropoietin for anemia of prematurity. A randomised trial. Pediatrics 1999; 104: 210-215.
10. Meyer MP, Haworth C, Meyer JH, Commerford A. A comparison of oral and intravenous iron supplementation in preterm infants receiving recombinant human erytropoietin. J Peditr 1996; 129: 258-263.
11. Soubasi V, kremenepoulus G, Diamendi E, et al. In which neonates does recombinant human erytropoietin treatment prevent anemia of prematurity: results of a randomised controlled study. Pediatr Res 1993; 34:675-79.,
12. CarnielliV, Montini G, Da Riol R, Dall’Amico R, Cantarutti F.Decreased ferritin levels,despite iron supplementation, during erytropoietin therapy in anemia of prematurity. Acta Pediatr 1996; 85:496-501.
13. Bader D, Blondheim O, Jonas R, et al. Decreased ferritin levels, despite iron supplementation, during erytropoietin therapy in anemia of prematurity. Acta Pediatr 1996; 85. 496-501.
14, Bechensteen AG, Haga P, Halversen S, et al. Erytropoietin, protein, and iron supplementation and the prevention of anemia of prematurity. Arch Dis Child 1993; 69: 19-23.
15 Bechensteen AG, Haga P, Halversen S, et al. Effect of low and moderate doses of recombinant human erytropoietin on the haematological response in premature infants on a high protein and iron intake. Eur J Pediatr 1997;156: 56-61.
16.. Huebers HA, Beguin Y, Pootrakul P, et al. Intact transferrin receptors in human plasma and their relation to erytropoiesis. Blood 1990;75:102-. 107.
17. Macdougall IC, Cavill |, Hulme B, et al. Detection of iron deficiency during erytropoietin treatment: a new approach. BM] 1992; 304:225- 226.
18. North M, Dallalio G, Donath AS, Melink R, Means RT. Serum transferrin receptor levels in patients undergoing evaluation of iron _ stores. Correlation with other parameters and observed versus predicted results. Clin. Lab. Haem. 1997; 19:93-97,
19. Doyle JJ. The role of erytropoietin in the anemia of prematurity. Sem Perinatol 1997;21: 20-27

There are 19 citations in total.

Details

Primary Language	English
Subjects	Pediatric Intensive Care
Journal Section	Research Article
Authors	Ayla Günlemez
Project Number	-
Publication Date	September 30, 2001
Published in Issue	Year 2001 Volume: 54 Issue: 3

Cite

APA	Günlemez, A. (2001). IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE? Ankara Üniversitesi Tıp Fakültesi Mecmuası, 54(3), 187-193.
AMA	Günlemez A. IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE? Ankara Üniversitesi Tıp Fakültesi Mecmuası. September 2001;54(3):187-193.
Chicago	Günlemez, Ayla. “IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 54, no. 3 (September 2001): 187-93.
EndNote	Günlemez A (September 1, 2001) IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE? Ankara Üniversitesi Tıp Fakültesi Mecmuası 54 3 187–193.
IEEE	A. Günlemez, “IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE?”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 54, no. 3, pp. 187–193, 2001.
ISNAD	Günlemez, Ayla. “IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 54/3 (September2001), 187-193.
JAMA	Günlemez A. IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE? Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2001;54:187–193.
MLA	Günlemez, Ayla. “IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE?”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 54, no. 3, 2001, pp. 187-93.
Vancouver	Günlemez A. IRON NEED DURING STIMULATED ERYTHROPOIESIS IN VERY LOW BIRTH WEIGHT PRETERMS: CAN SERUM CONCENTRATION OF TRANSFERRIN RECEPTOR BE USED AS AN ADDITIONAL MEASURE? Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2001;54(3):187-93.

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