The use of erythropoietin is being studied in newborns with hemolytic disease of the fetus and newborn (HDFN) suffering from anemia.
Administering erythropoietin to newborns can boost the red blood cell count and help reduce the need for blood transfusions and the onset of kernicterus and severe, potentially life-threatening consequences. In the case of severe anemia, blood transfusions remain the recommended treatment.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (Rh) factor (Rh-positive or Rh-negative) during pregnancy.
What is erythropoietin?
Erythropoietin is a naturally occurring glycoprotein hormone, also known as a growth factor, produced in the kidneys that stimulates red blood cell generation. It is often used to boost red blood cell production in cases of anemia. A synthetic version of erythropoietin can also be injected to supplement the erythropoietin produced by the body.
How does erythropoietin work?
The kidneys monitor the levels of oxygen in the blood, and when they drop as a result of anemia or hypoxia, more erythropoietin is produced and released into the bloodstream. When it reaches the bone marrow, it binds to erythropoietin receptors found on erythroid progenitor cells and causes them to activate their production into red blood cells.
The new red blood cells then enter the bloodstream and carry oxygen around the body. It can take several days or even weeks for the effects of erythropoietin to work and increase the red blood cell count.
Erythropoietin in HDFN
Anemia in newborns with HDFN is due to maternal antibodies that cross the placenta during pregnancy and seek to destroy the fetus’ red blood cells. Newborns can suffer from anemia and hyperbilirubinemia and require immediate treatment to avoid complications.
The use of erythropoietin is discussed as an alternative to blood transfusions in preterm newborns with HDFN-related anemia. It has also been shown to prevent the late onset of anemia in newborns with HDFN. However, it is not considered as a viable option for severe cases of anemia, as the benefits can be slow to arrive. Blood transfusions have more immediate results in alleviating anemia and are therefore the preferred option in critical cases.
Erythropoietin is usually given as an injection under the skin or intravenously. The treatment covers several weeks and in the case of injections, multiple injections per week are required. Oral iron supplements may also be given if the newborn is low in iron.
If you are experiencing an HDFN-affected pregnancy, you may want to talk to your healthcare team about the use of erythropoietin post-delivery.
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