#091 - 095 - Erythropoiesis Stimulating Agents

Hello Friends 👋

This week we are discussing erythropoiesis stimulating agents. Focusing primarily on erythropoietin, we cover a broad range of topics and issues. Daphna reviewed for us, on Monday, the physiology and mechanism of action of Erythropoietin. With this valuable information on hand, we continued with an interesting discussion on the evidence surrounding the use of erythropoieting for anemia. We then discussed the use of erythropoietin for neuroprotection, covering data for both preterm and term infants. On thursday we had the honor and the pleasure of welcoming to the show the famous Dr. Robin Ohls from the University of Utah who helped us clear up some important questions and clarify certain controversies surrounding the use of EPO in the NICU. As is customary, we finished our week with a series of interesting board review style questions. Please check out all of the resources below including the powerpoint presentation, link to articles, and importantly CME credits for the episodes this week.

Enjoy!

Access the presentation for this week here:

Claim CME Credits for episodes #091, #092, #093, #095

The Many Facets of Erythropoietin Physiologic and Metabolic Response

In mammals, erythropoietin (EPO), produced in the kidney, is essential for bone marrow erythropoiesis, and hypoxia induction of EPO production provides for the important erythropoietic response to ischemic stress, such as during blood loss and at high altitude. Erythropoietin acts by binding to its…

FrontiersAnna Bogdanova

The Effect of Epoetin Beta (Recombinant Human Erythropoietin) on the Need for Transfusion in Very-Low-Birth-Weight Infants | NEJM

Original Article from The New England Journal of Medicine — The Effect of Epoetin Beta (Recombinant Human Erythropoietin) on the Need for Transfusion in Very-Low-Birth-Weight Infants

New England Journal of MedicineRenew

Effects of early erythropoietin therapy on the transfusion requirements of preterm infants below 1250 grams birth weight: a multicenter, randomized, controlled trial - PubMed

The combination of early Epo and iron as administered in this study stimulated erythropoiesis in infants who were </=1250 g at birth. However, the lack of impact on transfusion requirements fails to support routine use of early Epo.neonate, intravenous iron, donor exposure.

PubMedR K Ohls

Early erythropoiesis‐stimulating agents in preterm or low birth weight infants - Ohlsson, A - 2020 | Cochrane Library

The Cochrane Library Trusted evidence. Informed decisions. Better health.Arne Ohlsson

Late erythropoiesis‐stimulating agents to prevent red blood cell transfusion in preterm or low birth weight infants - Aher, SM - 2020 | Cochrane Library

The Cochrane Library Trusted evidence. Informed decisions. Better health.Sanjay M Aher

Erythropoietin improves neurodevelopmental outcome of extremely preterm infants - PubMed

The results of our observational study confirm the hypothesis of a neuroprotective effect of rEpo in ELBW infants with IVH. This offers a promising preventative therapeutic option for the treatment of these high-risk infants.

PubMedAchim-Peter Neubauer

Erythropoietin concentrations and neurodevelopmental outcome in preterm infants - PubMed

Erythropoietin concentrations did not correlate with Psychomotor Development Index or overall incidence of neurodevelopmental impairment; however, infants with elevated erythropoietin concentrations had higher Mental Development Index scores than those with lower erythropoietin concentrations. Close…

PubMedRyann Bierer

Cognitive Outcomes of Preterm Infants Randomized to Darbepoetin, Erythropoietin, or Placebo

We previously reported decreased transfusions and donor exposures in preterm infants randomized to Darbepoetin (Darbe) or erythropoietin (Epo) compared with placebo. As these erythropoiesis-stimulating agents (ESAs) have shown promise as neuroprotective ...

PubMed Central (PMC)Robin K. Ohls

A Randomized Trial of Erythropoietin for Neuroprotection in Preterm Infants | NEJM

Original Article from The New England Journal of Medicine — A Randomized Trial of Erythropoietin for Neuroprotection in Preterm Infants

New England Journal of MedicineRenew

Erythropoietin improved neurologic outcomes in newborns with hypoxic-ischemic encephalopathy - PubMed

Repeated, low-dose, recombinant human erythropoietin treatment reduced the risk of disability for infants with moderate HIE, without apparent side effects.

PubMedChanglian Zhu

High-Dose Erythropoietin and Hypothermia for Hypoxic-Ischemic Encephalopathy: A Phase II Trial - PubMed

High doses of Epo given with hypothermia for hypoxic-ischemic encephalopathy may result in less MRI brain injury and improved 1-year motor function.

PubMedYvonne W Wu

Systematic review seeking erythropoietin role for neuroprotection in neonates with hypoxic ischemic encephalopathy: presently where do we stand - PubMed

EPO treatment has neuroprotective effects against moderate/severe HIE and improves long-term behavioral neurological developments in neonates.

PubMedBhawandeep Garg

Update on Erythropoiesis-Stimulating Agents Administered to Neonates for Neuroprotection - PubMed

Erythropoiesis-stimulating agents (ESAs) such as erythropoietin and darbepoetin have been studied as red blood cell growth factors in preterm and term infants for more than 30 years. Recently, studies have focused on the potential neuroprotective effects of ESAs. In this review, we summarize preclin…

PubMedJessie R Maxwell