Anemia in premature infants is extremely common. Precise quantitation of iron status and determination of iron incorporation into erythrocytes are important in monitoring therapy for anemia in premature infants, especially when treating with recombinant human erythropoietin (rhEPO). However, the traditional indices of the iron status have limited usefulness in this population. The goal of the current work is to develop an experimental animal model system that addresses the clinical issue relating to quantitation of iron delivery to erythrocytes. We first determined normal hematological values for nontreated, dam-suckled Sprague-Dawley rats by measuring markers of erythropoiesis and iron status during the first 12 postnatal days (PND). The experimental group of rats were administered parenteral rhEpo (430 IU·kg–1 · day–1) for 8 days (from PND 4 until PND 12) in the absence (rhEpo–Fe) or presence (rhEpo+Fe) of oral iron supplementation (6 mg·kg–1·day–1). Rat pups receiving oral iron only (control+Fe) and pups that were sham fed with the orogastric tube (control–Fe) were included as controls. Hematological parameters were measured in blood and bone marrow. In a pattern similar to that seen in premature infants during the first 2 months of life, the levels of these hematopoietic markers were dynamic and changed during the first 12 PND. After challenging experimental animals with subcutaneous rhEpo, evidence of iron-deficient erythropoiesis was seen in the rhEpo–Fe group. Red blood cell levels and absolute reticulocyte counts were higher in both groups receiving rhEpo as compared with the controls. However, the rhEpo–Fe group experienced a lower hemoglobin level, a lower mean red cell volume, a greater red cell distribution width, and a higher zinc protoporphyrin/heme (ratio than the rhEpo+Fe group. The neonatal rat is an excellent model of iron-deficient erythropoiesis and will be useful in designing future mechanistic studies examining the interplay between iron and erythropoiesis in the anemic, iron-challenged premature neonate.

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