Profile of anemia in children after liver transplantation.

Background. Clinical and hematological profile of chronic anemia in children after orthotopic liver transplantation (OLT) is unknown. Methods. We prospectively studied children after orthotopic liver transplantation (OLT) with hemoglobin levels < 2 standard deviation of age appropriate mean for > 6 months. Investigations included hemogram, reticulocyte count, peripheral blood smear, serum vitamin B-12, folic acid levels, iron studies, and stool and urine tests for occult blood. Results. Fifty-six participants (22 male and 34 female, mean age 82.9 months, range 20-232, mean post-OLT duration 48.8 months, range 6-132) were studied. The causes of anemia were idiopathic (32), iron deficiency (4), viral infections (2, HIV=1, parvovirus=1), and lymphoproliferative disease (2). Fifteen participants showed spontaneous recovery within 1-6 months. Thirty-one children with idiopathic anemia had low or normal EPO levels (mean 7.33 mmu/L, range <2.5 to 15.9, normal 4-24). When outliers (iron deficiency=4, HIV disease=1) were excluded, there was no statistical correlation between hematocrits and EPO levels. Serum vitamin B-12 levels (n=52) were elevated (normal 110-930 pg/ml) (mean=1186 pg/ml) in 32 (61.5%) and were significantly higher in those with abnormal liver function tests. Conclusion. Anemia is a common problem in children after OLT. More then half the participants had anemia of unknown etiology with an inappropriate EPO response for the degree of anemia. The normal negative correlation between hematocrit and EPO was lost in these children. The observation regarding serum vitamin B-12 levels requires further study.