losartan-potassium and Jaundice--Neonatal

In the United States in 1991, 290,000 or 7.1% of the 4,110,907 live births were premature infants; 53,299 or 1.3% were infants with birth weights of less than 1500 grams. Many if not all of these very low birth weight infants will require red blood cell transfusions for one of several reasons. These include exchange transfusions for hyperbilirubinemia, but most often transfusions are simple small volume transfusion also called 'topper' transfusions. Most of these small volume transfusions are given for iatrogenic blood loss or 'bleeding into the laboratory.' Studies have demonstrated that the sicker the infant, the more blood sampling is needed and the greater the exposure to red blood cell (RBC), platelet and plasma products. Simple RBC transfusions may also be given for specific clinical indications or to maintain a predetermined hemoglobin concentration. This manuscript will review the criteria for RBC transfusion in neonates and selection of product as regards anticoagulant and specialized processing. In addition, the results of recombinant erythropoietin (r-EPO) clinical trials in neonates will be discussed.

Topics: Blood; Blood Donors; Blood Transfusion; Bloodletting; Cytomegalovirus Infections; Erythrocyte Transfusion; Erythrocyte Volume; Erythropoietin; Failure to Thrive; Graft vs Host Disease; Hematocrit; Humans; Infant, Low Birth Weight; Infant, Newborn; Jaundice, Neonatal; Oxygen; Recombinant Proteins; Transfusion Reaction

The newborn with hereditary spherocytosis can develop severe anemia, requiring red blood cell transfusions. Therapy with r-HuEPO has been proposed to avoid transfusions.. Hereditary spherocytosis was diagnosed in a newborn who had severe and early jaundice. He was treated with r-HuEPO, and did not require red blood cells transfusion.. Recombinant erythropoïetin might be an interesting alternative to red blood cells transfusions during the neonatal period in newborns with hereditary spherocytosis.

Topics: Drug Administration Schedule; Erythrocyte Transfusion; Erythropoietin; Hematocrit; Hemoglobins; Humans; Infant, Newborn; Injections, Subcutaneous; Jaundice, Neonatal; Male; Phototherapy; Recombinant Proteins; Reticulocyte Count; Spherocytosis, Hereditary; Time Factors; Treatment Outcome

A postnatal hyporegenerative anemia may complicate Rh hemolytic disease. Intramedullary hemolysis, bone marrow suppression, and erythropoietin deficiency have been implicated etiologically. Treatment with recombinant erythropoietin (r-EPO) has yielded encouraging preliminary results. The authors describe an infant with Rh isoimmunization who developed severe hyporegenerative anemia unresponsive to a 5-week course of r-EPO. Two additional doses at 12 weeks resulted in brisk reticulocytosis, coinciding with a 16-fold decline in the anti-Rh(D) antibody titer. Thus, treatment with r-EPO may be ineffective when anti-Rh(D) antibody titers are high. The authors also show that erythropoietin deficiency in hyporegenerative anemia is not as frequent and severe as originally thought.

Topics: Adult; Anemia; Blood Transfusion, Intrauterine; Cholestasis, Intrahepatic; Drug Resistance; Erythroblastosis, Fetal; Erythrocyte Transfusion; Erythropoiesis; Erythropoietin; Female; Ferritins; Hepatomegaly; Humans; Immunity, Maternally-Acquired; Infant, Newborn; Iron Overload; Isoantibodies; Jaundice, Neonatal; Phototherapy; Pregnancy; Recombinant Proteins; Reticulocyte Count; Rh Isoimmunization; Rho(D) Immune Globulin; Time Factors