Neonatal anemia: pathophysiology and treatment.

All neonates experience a decline in circulating red blood cell (RBC) mass due to diminished erythropoietin (EPO) levels. This effect is more pronounced in small, premature infants and can lead to severe anemia and need for RBC transfusions--particularly, if repeated phlebotomy is required to monitor acutely-ill neonates. Although optimal RBC transfusion therapy has been a long-term challenge for neonatologists, the emergence of recombinant EPO as promising therapy for neonatal anemia is the major issue for 1994. Accordingly, this report for the 12th International Convocation on Immunology (Transfusion Immunology and Medicine) will focus on this aspect of neonatal transfusion medicine. Although several controlled trials to evaluate EPO as therapy have been completed, definitive answers to all questions regarding efficacy and possible toxicity have not been provided. However, therapy with EPO plus iron and adequate nutrition is likely to be proven effective for the relatively late anemia of stable prematures. To date, EPO has not been shown, convincingly, to alleviate the anemia present early in the life of acutely-ill, premature infants.