1083: THERAPEUTIC ROLE FOR ERYTHROPOIETIN IN A PEDIATRIC INTENSIVE CARE UNIT

Abstract

Erythropoietin (EPO) is frequently used to enhance erythropoiesis in anemic patients to avoid unnecessary transfusions. However, data to support its utility in pediatric intensive care unit (PICU) patients is lacking. This is in part due to the fact that most transfusions occur within the first 48 hours of admission. There may be a subgroup of patients who may benefit from EPO therapy to prevent later transfusions. The purpose of this study is to explore the clinical rationale and assess the efficacy of EPO in certain PICU patients at risk of requiring blood transfusion.

EPO administration will result in significant rise in hemoglobin in anemic patients in the PICU.

A retrospective review of all patients admitted to a tertiary care PICU in 2010 and 2011 that received EPO. Diagnosis, PRISM scores, hemoglobin values (Hgb), number of EPO doses, and transfusions were recorded. Mann-Whitney test and regression analysis were utilized. Values were expressed in means and standard deviations.

Of 2595 admissions, 110 received EPO. The average age of the 110 patients (51 females and 59 males) was 7.4 ± 5.4 years and the median PRISM score was 3. Of these, 8 patients had ongoing blood loss and were excluded, 33 were transfused (Group A) and 69 were not (Group B). Pre EPO Hgb was 7.6 gm/dl ± 1.4 vs. 8.8 gm/dl ± 1.2 for group A and B respectively (p =.78). Regression analysis revealed that a higher PRISM score predicted need for transfusions (p =.024). In group B, Hgb rise following EPO therapy was significant in trauma (1.0 gm/dl, p =.018, n = 9) and post-operative (± 0.87 gm/dl, p =.012, n = 31) patients, but not in patients with infections (0.23 gm/dl, p =.573, n = 20). Patients receiving? 3 doses of EPO had higher Hgb rise (1.06 gm/dl ± 1.52) compared to those receiving fewer doses (0.3 gm/dl ± 1.4), p =.05. There were no reported complications.

EPO induced a significant hemoglobin rise in sub-acute trauma and post-operative patients but not in patients with infections. Fewer than 3 doses of EPO were not effective, and PRISM score predicted transfusion requirement. This data will be helpful in targeting specific populations in future prospective studies.