Erythropoietin in Hemolytic Uremic Syndrome
Erythropoietin in Hemolytic Uremic Syndrome
This study will evaluate the impact of early administration of erythropoietin in the number
 of red blood cell transfusions in children with Shiga toxin-producing Escherichia coli
 hemolytic uremic syndrome (STEC-HUS).
Introduction:

 Anemia in STEC-HUS is treated with red blood cell (RBC) transfusions. It can causes
 hypervolemia, hyperkalemia, exacerbate the thrombotic state of the disease, transmit
 infectious agents and trigger antigenic sensitization. Anemia is mainly due to hemolysis, but
 deficit of erythropoietin synthesis (EPO) may aggravate it. Although recombinant human EPO is
 frequently used in children with STEC-HUS there is no adequate evidence of its benefit. If it
 is confirmed that EPO reduce the number of RBC transfusions, its administration could
 diminish the aforementioned risks and also reduce costs.

 Objective:

 To determine if EPO administration decreases the number of RBC transfusions and; secondarily,
 to assess if its levels influence on transfusion requirement.

 Methodology:

 Randomized, open controlled clinical trial. We will include 28 patients (14 per arm) <18
 years with STEC-HUS admitted to our hospital. They will be grouped after randomization:(1)
 One to standard of care (RBC transfusions with hemoglobin ≤7 mg / dl and/or hemodynamic
 instability) and (2) the other to standard of care plus EPO (50 u / kg subcutaneous three
 times weekly) and RBC transfusions with hemoglobin ≤7 mg / dl). Serum EPO will be measured by
 ELISA and together with the clinical and laboratory variables, association with RBC
 transfusions number will be sought. Written informed consent and assent when appropriate,
 will be requested prior to enter into the study.
Inclusion Criteria:

 -  Post diarrheal HUS: Prodrome of enteritis followed by microangiopathic hemolytic
 anemia, thrombocytopenia and signs of renal damage (increased plasma creatinine,
 proteinuria, and / or hematuria). Proven STEC infection wiil not be required to enter
 into the study.

 Exclusion Criteria:

 -  Atypical HUS

 -  HUS associated with systemic diseases (pneumococcal infection, HIV, Systemic lupus
 erythematosus) or drugs

 -  Anemia or known kidney disease

 -  Previously transfused or treated with erythropoietin

 -  Contraindications to erythropoietin