The Effect of Recombinant Erythropoietin in the Treatment of Anemia of Prematurity: A Review Study

Introduction: Erythropoietin is an essential hormone for Erythropoiesis. Since the late 1980s, a recombinant human Erythropoietin compound for the treatment of anemia in premature infants has been studied. Contrary to the studies, the researcher tried to determine the effect of recombinant Erythropoietin in the treatment of anemia in premature infants. Method: The review was carried out with a database of ISI, SCOPUS, PUPMED, Schoolar, Magiran, SID in the 10-year period (2008-20018).Results: Finally, 22 articles were examined. In 6 articles, administration of oral Erythropoietin significantly increased the serum level of EPO and the number of serum reticulocytes, but no significant changes were observed in HB, HCT, but in 5 other articles, in addition to the increase the level of EPO and the number of serum reticulocytes, HB, and HCT also increased.In the study of the increase in ROP (retinopathy of prematurity) levels for infants treated with EPO, it was observed that according to this study and clinical cases due to the risk of increasing ROP, EPO is not recommended; However in another study, the administration of Erythropoietin did not increases the risk of ROP in any of the stages.It has been observed in studies that rhEPO (recombinant human erythropoietin) and oral iron have a significant role in the treatment of anemia in premature infants and increase hematocrit in these patients, which can be a minimized blood transfusion in these infants. In another study, Folate (vitamin B9) and vitamin B12 significantly increased EPO for hematopoiesis. Combination therapy with Folate and vitamin B12 and iron with EPO seems to be more effective in stimulating the hemorrhage of infants.In one study, it was shown that the onset of treatment with rhEPO is effective as a result of treatment, and if treatment starts sooner, the more favorable results will be achieved.Another study showed that the effect of rhEPO is also dependent on the purpose of treatment. The long-term use of EPO is likely to increase the probability of an outbreak and the development of certain diseases, such as Hemangioma, liver failure, etc. According to this study, EPO can be used in two forms of PO (oral) and SC (subcutaneous), while the effectiveness of SC is greater for the treatment of this disease, while another study showed that oral and intravenous EPO treatments have the same effect on anemia in premature infants, but most oral doses are recommended. According to this study, the disadvantages of this method can be the severe reduction of RBCTK (Erythrocyte Transketolase Activity) in neonates VLBW (Very Low Birth Weight).Conclusion: The effect of rhEPO therapy on the anemia of premature infants depends on a number of factors. The role of auxiliary oral iron, vitamin B and B12 alone cannot be effective for the complete elimination of transfusion (blood transfusion). The correction of bleeding techniques and the reduction of blood sample sizes for laboratory tests can reduce the transfusion, but still the role of rhEPO therapy in the VLBW population is considered and treatment with EPO is more effective than common treatments for the improvement of anemia in premature infants.