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Treatment of Anemia of Prematurity

Anemia is a condition in which the body does not produce enough red blood cells (RBCs).

The best way to treat anemia is to create conditions that reduce the likelihood of its development. To help prevent anemia, the smallest possible amount of blood is taken from a premature baby whenever a blood test is needed. Additionally, optimal nutrition can decrease the likelihood that an iron or vitamin deficiency will occur. Supplemental iron will likely also be administered once the baby is a few weeks old.

If anemia does occur, these two strategies will continue but may be augmented by other treatments. The decision to provide additional treatment is influenced by the gestational age, birthweight, postnatal age, and general condition of the premature baby. Additional treatment may not be necessary, especially if the anemia is mild and there do not appear to be any adverse effects for the premature baby.

On the other hand, a blood transfusion may be recommended. Generally speaking, while blood transfusion has the immediate effect of increasing RBC levels, it also often has the effect of suppressing the baby’s erythropoietin level. Erythropoietin is a hormone which stimulates the production of RBCs, so when the transfusion suppresses erythropoietin, it slows down the ongoing production of RBCs. However, the baby will usually begin producing his own erythropoetin shortly after the blood transfusion.

Blood for transfusion is cross-matched to avoid blood group incompatibility between the donor and the premature baby. The blood is carefully screened for the hepatitis A, B, and C viruses, cytomegalovirus, and human immunodeficiency virus (HIV) to minimize the likelihood of transmission of a viral infection.

In many hospitals, it is possible for the premature baby’s parent to make a directed donation to the baby. The parent and baby must have compatible blood groups, and the parent’s blood must be free of infection. A directed donation is no safer than a donation from any other suitable donor.

A drug called a diuretic, which causes an increased urine output, may be given during or shortly after a blood transfusion if there is concern that the baby is experiencing fluid overload. There is no need to give a diuretic routinely with a blood transfusion. Furosemide is the most commonly used diuretic.

Since the physiological anemia of infancy occurs as a result of a lack of erythropoietin, there has been considerable interest in giving supplemental erythropoietin to premature babies. Supplemental erthyropoetin is generally given by injections under the skin one to three times a week for a period of four to six weeks. RBC production increases and the impact of the physiological anemia of infancy can be reduced. However, blood transfusions are still required, especially during the first few days of life.

Although erythropoietin is not used routinely for the treatment of anemia of prematurity, it may be useful in special circumstances. Erythropoietin may make a valuable contribution to the care of those premature babies whose parents are Jehovah Witnesses, who usually refuse blood transfusions on religious grounds.

More information

Andrew James, BSc, MBChB, FRACP, FRCPC

Aideen Moore, MD, FRCPC, MRCPI, MHSc