417 Iron Absorption and Red Blood Cell Incorporation Following Enteral and Intravenous Administration in Erythropoietin-Treated Premature Infants

Abstract

Background: Clinically important information regarding iron absorption and erythrocyte incorporation in infants is incomplete.

Methods: A prospective, controlled, randomized, open, 18-day treatment trial was conducted in infants <1,300 g and <31 wks at birth to assess the efficacy of intravenous (IV) iron sucrose in combination with recombinant human erythropoietin (r-HuEPO) in increasing red blood cell (RBC) iron incorporation, enteral iron absorption, and erythropoiesis. Three groups of clinically stable infants were enrolled at 3–4 wks of age: 1) Control; 2) EPO (2,100 U r-HuEPO/kg-wk); and 3) IV Iron (Fe) + EPO (2 mg IV Fe sucrose/kg-d plus 2,100 U r-HuEPO/kg-wk). All infants received 9 mg/kg-d of enteral Fe polymaltose (IPC), but were not permitted to receive RBC transfusions. Indicators of iron status and erythropoiesis were assessed before and after treatment. On day 4, tracer doses of enteral 57Fe polymaltose and IV 58Fe sucrose were administered with subsequent stool and blood samples collected to determine Fe absorption and RBC Fe incorporation.

Results: Compared to Control and EPO Groups, the IV Fe + EPO Group demonstrated greater total RBC Fe incorporation along with greater increases in hemoglobin (Hb) concentration, reticulocyte counts, and plasma ferritin (Table). Compared to Controls, the EPO Group demonstrated greater increases in Hb concentration and reticulocyte counts, but not in RBC Fe incorporation. Absorption of 57Fe and non-isotopic Fe polymaltose were similar among the three study groups.

Table 1

Conclusions: In summary, IV Fe sucrose administered in combination with r-HuEPO to VLBW premature infants significantly increases RBC Fe incorporation and erythropoiesis above that of r-HuEPO alone without increasing iron absorption. Based on the present data, future studies in which IV iron and r-HuEPO dosing are modified with the purpose of achieving greater erythropoietic stimulation for achieving greater reductions in RBC transfusions are warranted.

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