Treatment with darbepoetin alfa appears to reduce transfusion requirements for patients with hemolytic disease of the fetus and newborn (HDFN) and should be considered as a viable therapeutic alternative for the disease, according to a recently published study in Lancet Hematology.
HDFN is characterized by antibody-mediated fetal red blood cell destruction, which can result in severe anemia after birth. Current therapeutic strategies for the postnatal care of HDFN include blood transfusion and phototherapy; these measures are meant to improve hemoglobin levels and reduce bilirubin levels; without treatment, HDFN can lead to complications such as permanent neurological damage (kernicterus).
However, transfusions are an invasive procedure that can cause severe side effects. Furthermore, some patients can require excessive transfusions due to hyporegenerative anemia, a condition in which hematopoiesis, the process by which the bone marrow produces red blood cells, is impaired due to a deficiency of an enzyme called erythropoietin.
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Erythropoietin is a molecule produced by the kidneys that stimulates the bone marrow to produce more red blood cells. Patients who underwent intrauterine transfusions as well as exchange transfusions after birth can develop an erythropoietin deficiency that, in turn, increases the need for more transfusions, eventually creating a vicious cycle.
Synthetic agents such as darbepoetin alfa can mimic the effects of erythropoietin, thus decreasing the need for transfusions. Current research on the benefits of erythropoiesis-stimulating agents (ESAs) has shown mixed results, with some studies showing significant benefits and others reporting low efficacy.
“We aimed to evaluate the effect of exogenous erythropoietin on the prevention of postnatal anemia in infants with haemolytic disease of the fetus and newborn,” the authors wrote.
The study included 76 infants with HDFN that were divided into two groups. The first group received treatment with darbepoetin alfa, and the second received only standard therapy for postnatal HDFN.
After three months, researchers observed that patients who received darbepoetin required significantly fewer transfusions than those who received only standard treatments. No significant adverse effects were associated with treatment or deaths during the study.
“Treatment with darbepoetin alfa or other types of erythropoietin should be considered as part of the postnatal treatment of severe haemolytic disease of the fetus and newborn,” the authors concluded.
