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

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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.

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Acknowledgments

This investigator initiated study was supported by a grant from Hoffmann la Roche AG Germany (Grenzach-Wyhlen).

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Hepatology and Metabolic Diseases, Medical School of Hannover, Carl-Neuberg-Straße 1, 30655, Hannover, Germany

    Lars Pape, Thurid Ahlenstiel, Martin Kreuzer, Jens Drube, Kerstin Froede, Doris Franke & Jochen H. H. Ehrich

  2. Department of Nephrology and Hypertensive Diseases, Medical School of Hannover, Hannover, Germany

    Marion Haubitz

Authors
  1. Lars Pape
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  2. Thurid Ahlenstiel
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  3. Martin Kreuzer
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  4. Jens Drube
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  5. Kerstin Froede
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  6. Doris Franke
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  7. Jochen H. H. Ehrich
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  8. Marion Haubitz
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Correspondence to Lars Pape.

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Pape, L., Ahlenstiel, T., Kreuzer, M. et al. Early erythropoietin reduced the need for red blood cell transfusion in childhood hemolytic uremic syndrome—a randomized prospective pilot trial. Pediatr Nephrol 24, 1061–1064 (2009). https://doi.org/10.1007/s00467-008-1087-4

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  • DOI: https://doi.org/10.1007/s00467-008-1087-4

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