Erythropoietin (Epoetin Alfa/Beta — Anaemia of Prematurity)

How it works

It is a recombinant analogue of endogenous erythropoietin that binds erythropoietin receptors on erythroid progenitor cells in the bone marrow, stimulating their proliferation, differentiation and maturation into red cells.

Prescribing in practice

• Effective erythropoiesis depends on adequate iron stores, so concurrent iron supplementation is generally required and erythropoietin will be ineffective in iron-deficient infants.
• Reserve for selected preterm infants in line with local neonatal protocols, as routine use does not reliably abolish the need for transfusion.
• Prescribe and dose according to a children's formulary and the SPC, and adjust according to haematological response.

Monitoring

Monitor haemoglobin/haematocrit, reticulocyte count and iron status (including ferritin) during therapy.

Counselling the patient

• Explain to the family that treatment aims to reduce the number of blood transfusions the baby may need.
• Iron supplements are given alongside to allow the medicine to work.
• Several weeks of treatment are usually needed before a sustained rise in red cells is seen.

Evidence & guidelines

Cochrane reviews indicate erythropoiesis-stimulating agents modestly reduce transfusion exposure in preterm infants, though the clinical significance is debated and practice varies between units.