Brief Report

Pediatric Nephrology

, Volume 24, Issue 5, pp 1061-1064

First online:

Early erythropoietin reduced the need for red blood cell transfusion in childhood hemolytic uremic syndrome—a randomized prospective pilot trial

  • Lars PapeAffiliated withDepartment of Pediatric Nephrology, Hepatology and Metabolic Diseases, Medical School of Hannover Email author 
  • , Thurid AhlenstielAffiliated withDepartment of Pediatric Nephrology, Hepatology and Metabolic Diseases, Medical School of Hannover
  • , Martin KreuzerAffiliated withDepartment of Pediatric Nephrology, Hepatology and Metabolic Diseases, Medical School of Hannover
  • , Jens DrubeAffiliated withDepartment of Pediatric Nephrology, Hepatology and Metabolic Diseases, Medical School of Hannover
  • , Kerstin FroedeAffiliated withDepartment of Pediatric Nephrology, Hepatology and Metabolic Diseases, Medical School of Hannover
  • , Doris FrankeAffiliated withDepartment of Pediatric Nephrology, Hepatology and Metabolic Diseases, Medical School of Hannover
  • , Jochen H. H. EhrichAffiliated withDepartment of Pediatric Nephrology, Hepatology and Metabolic Diseases, Medical School of Hannover
  • , Marion HaubitzAffiliated withDepartment of Nephrology and Hypertensive Diseases, Medical School of Hannover

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Abstract

Childhood hemolytic uremic syndrome (HUS) is most often caused by enterohemorrhagic Escherichia coli (EHEC). Due to severe hemolysis, red blood cell (RBC) transfusions are often necessary, and anemia is aggravated by low erythropoietin (EPO) levels caused by acute renal failure. In a single center, prospective study, we randomized ten children with EHEC-positive HUS into two therapeutic groups: one receiving EPO treatment (median age 2 years, age range 1–3 years) and the other receiving standard therapy (median age 2 years, age range 1–6 years). Red blood cell transfusions were performed when the hemoglobin level (Hb) fell below 5 mg/dl. The number of RBC transfusions was compared in both groups. The Hb level at admission was comparable between both groups (6.4 vs. 8.1 mg/dl, P > 0.05, t-test). However, children in the EPO group required a significantly lower mean number of RBCs than those in the non-EPO group (0.2 vs. 1.4, P < 0.04, t-test). Based on these results, we suggest that the early administration of EPO at the time of hemolytic anemia and beginning renal failure may attenuate renal anemia in children with EHEC-induced HUS and thereby reduce the number of RBC transfusions required. The results of this pilot study will have to be confirmed in a larger multicenter trial.

Keywords

Erythropoietin Free endothelial cells Hemolytic uremic syndrome