Edema and Hemolytic Anemia in Premature Infants

Abstract

Widespread edema, anemia, reticulocytosis, thrombocytosis and vitamin E deficiency were noted in seven premature infants during the second month of life. Appropriate studies excluded the usual causes of these findings. The erythrocyte survival times, measured by means of DF32P and 51Cr, were strikingly short, confirming the hemolytic nature of the anemia. All infants had been fed commercial formulas with iron and a high content of polyunsaturated fatty acid, resulting in a low ratio of vitamin E to fatty acids. When vitamin E (alpha-tocopherol acetate), 75 to 100 IU daily, was given separately by mouth to five infants available for treatment and study, serum tocopherol level rose, reticulocyte count fell to normal and erythrocyte survival time lengthened; this was followed by correction of the anemia, clearing of the edema and subsidence of the thrombocytosis. Formulas having low ratios of vitamin E to polyunsaturated fatty acids and added iron supply, an inadequate amount of vitamin E to low-birth-weight infants, in whom vitamin E deficiency may be a common and important cause of anemia and edema.