In this section
Anaemia is a term used to describe a lower
than normal number of red blood cells and less of the oxygen
carrying pigment (haemoglobin) in the blood. Red blood cells supply
all parts of the body with oxygen. When there is a lowered number
of red blood cells in the blood, your child may feel tired and
breathless, and may not have enough energy or be able to
concentrate effectively for normal schooling or playing.
There are many causes of anaemia. The main
cause of anaemia, in children with kidney failure, is a reduced
production of a hormone called erythropoietin, which is normally
produced by the kidneys.
A simple blood test called "full blood count"
(also known as FBC or FBE) which includes a haemoglobin level (also
known as Hb) will show if your child is anaemic. Children with
kidney failure have this test done often, to determine if treatment
is required for anaemia.
As your child's kidneys make less
erythropoietin than is needed, a medication called Aranesp, is
prescribed. Aranesp is a protein, which is very similar to
naturally occurring erythropoietin. It stimulates the bone marrow
to produce more red blood cells, therefore improving anaemia and
the symptoms of anaemia.
At the present time there are 2 forms of
erythropoietin products available in
Australia. They are both given either as
an injection into the skin or given directly into the vein.
Darbepoetin alfa (Aranesp) is prescribed at
the Royal Children's Hospital.
Children who are being treated with Aranesp
will more than likely need to be given an iron supplement. Iron
isneeded in order to make haemoglobin within the red blood cells,
and Aranesp draws on iron reserves within the body. Iron storage
levels are measured at the time of commencement of Aranesp
treatment, and are then monitored every few months. Iron can be
given by intravenous infusion over a few hours or alternatively as
medicine or tablets.
Side effects of
Like all medications there are possible side
effects. The following side effects have been reported although
none of them are very common:
What if your child
experiences any side effects?
Any side effects your child may experience
should be reported to his/her nephrologist. Sometimes they will
need to be investigated as to whether the cause of the problem is
related to Aranesp treatment. Changes to Aranesp treatment may
sometimes be needed. Injection site pain may be helped by taking
the injection out of the fridge about 20 minutes before using it,
so as to allow it to warm to room temperature. (You should
never try to warm the Aranesp injection, as this could alter the
chemistry of the drug).
Pure Red Cell Aplasia (PRCA) is a condition
where the body develops antibodies to erythropoietin. If PRCA is
diagnosed, erythropoietin products need to be ceased. These
patients need regular blood transfusions to maintain a normal red
blood cell count. This complication is very rare, occurring between
1:1000 and 1:10,000 cases of individuals taking erythropoietin
products. To date, no cases of PRCA have been reported in those who
have only had Aranesp treatment.
Storage and Transportation of Aranesp
is very important
Aranesp syringes should be stored in the
refrigerator (between 2° and 8° C), away from light.
Do not freeze or do not shake the Aranesp
Aranesp is stable out of the refrigerator (not
below -20°C or above 30°C) for up to 2 days.
An Esky or "Aranesp coolie bag" will need to
be used on extremely hot days to transport the syringes home from
the hospital pharmacy. The hospital pharmacy department will
usually provide you with an Esky to transport the syringes home if
this is necessary.