Autologous blood transfusion with recombinant human erythropoietin in heart operations

Watanabe, Yasunori; Fuse, Katsuo; Konishi, Toshio; Kobayasi, Toshiya; Takazawa, Kenji; Konishi, Hiroaki; Shibata, Yoshiyuki

doi:10.1016/0003-4975(91)90122-7

Cited by 69 publications

(14 citation statements)

References 8 publications

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“…Oral iron supplementation was insufficient to guarantee adequate iron supply to the bone marrow. Although intravenous iron may be adequate therapy to restore iron blanace [30,31], it is not free of severe side-effects, such as anaphylaxis. As an alternative, autologous blood donors may be treated with oral iron for a reasonable period before initializing rhEPO therapy in order to rule out the development of iron deficiency.…”

Section: Discussionmentioning

confidence: 99%

Erythropoietic activity and iron metabolism in autologous blood donors during recombinant human erythropoietin therapy

Biesma¹,

Wiel²,

Béguin

et al. 1994

Eur J Clin Investigation

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The use of recombinant human erythropoietin (rhEPO) to intensify the erythropoietic response in autologous donors may reduce homologous blood requirement. We studied the effect of subcutaneous rhEPO (500 U kg-1 body weight twice weekly during a 3 week period) on variables of erythropoiesis and iron metabolism in 62 autologous blood donors, of whom 32 received rhEPO (epo group) and 30 did not (control group). Patients donated only 2 units of blood and received oral iron in order to restrict phlebotomy-induced decrease of iron stores. Pre-phlebotomy haemoglobin concentration (14.0 +/- 0.8 g dl-1) was completely regenerated in the epo group at surgery (13.7 +/- 1.3 g dl-1); haemoglobin concentration in the control group fell from 13.5 +/- 1.4 g dl-1 to 11.6 +/- 1.4 g dl-1 after the phlebotomies and did not improve during the pre-operative phase. Total erythropoietic activity expressed as serum transferrin receptor concentration (sTfR) showed a 4-fold increase from 3.8 +/- 0.9 micrograms ml-1 to 14.9 +/- 4.8 micrograms ml-1 in the epo group. Effective erythropoietic activity measured by absolute reticulocyte count, however, declined after the fourth rhEPO injection in the epo group. Serum ferritin was lower in the epo group, but no differences in serum iron, transferrin concentration and transferrin saturation were observed between the groups. A marked increase in free erythrocyte protoporphyrin (FEP) was observed in the epo group, whereas FEP levels in the controls remained within normal ranges. Despite oral iron supplementation and the limited number of phlebotomies, the effect of rhEPO therapy in autologous donors is restricted by iron depletion.

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Section: Discussionmentioning

confidence: 99%

Erythropoietic activity and iron metabolism in autologous blood donors during recombinant human erythropoietin therapy

Biesma¹,

Wiel²,

Béguin

et al. 1994

Eur J Clin Investigation

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“…This practice may reduce the number of patients with sufficient preoperative time for Epoetin alfa treatment. Parenteral administration of iron enhances the response to Epoetin alfa [12] and may offset the effects of a reduced preoperative interval. Another option is to evaluate whether extending the duration of postoperative Epoetin alfa therapy and iron supplementation would have an impact on the need of postoperative transfusion.…”

Section: Commentmentioning

confidence: 99%

Effect of Recombinant Human Erythropoietin on Transfusion Risk in Coronary Bypass Patients

D’Ambra

Gray

Hillman

et al. 1997

The Annals of Thoracic Surgery

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Background. Patients having a cardiac operation frequently require allogeneic blood transfusions despite surgical blood-conservation techniques. Recombinant human erythropoietin (Epoetin alfa) may augment this conservation by stimulating erythropoiesis. The safety and efficacy of perioperative use of Epoetin alfa to reduce the need of allogeneic transfusion was studied.Methods. A multicenter double-blind, placebo-controlled, parallel-group study involved 182 patients having coronary artery bypass grafting and randomized to receive Epoetin alfa (300 or 150 IU/kg) or placebo subcutaneously for 5 days before, on the day of, and for 2 days after operation.Results. Perioperative Epoetin alfa resulted in greater increases in baseline to preoperative hemoglobin levels

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“…Previous studies in orthopedic and cardiac surgery patients showed that preoperative administration of r–HuEPO stimulated erythropoiesis allowing an increase of the number of units of autologous blood collected and a decrease of both autodonation–induced anemia and timing of the donation program [10, 11, 12, 13, 14, 15]. However, only a few of the aforementioned studies showed that r–HuEPO significantly reduced the need for homologous transfusion.…”

Section: Discussionmentioning

confidence: 95%

Erythropoiesis after Therapy with Recombinant Human Erythropoietin: A Dose–Response Study in Anemic Cancer Surgery Patients

et al. 1999

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Background and Objectives: Preoperative treatment with 600 U/kg of recombinant human erythropoietin (r–HuEPO) effectively increases erythropoiesis in cancer patients. The aim of this study was to evaluate the erythropoietic response after different doses of r–HuEPO in order to find the minimum effective dose. Materials and Methods: Twenty anemic sideropenic patients (hemoglobin ≤110 g/l; serum iron <600 μg/l) with cancer of the gastrointestinal tract were randomly allocated to two groups: the first (n = 10) received 400 U/kg of r–Hu EPO divided in 4 doses (100 U/kg each, every 4 days); the second (n = 10) received 200 U/kg of r–HuEPO (50 U/kg each, every 4 days). Both groups were given intravenous iron gluconate (125 mg) every day for 15 days. Results: After treatment, the serum iron level significantly rose in both groups. The production of new red blood cells was 176.3±90.8 ml in the 200 U/kg group and 268.4±79.4 ml in the 400 U/kg group (p = 0.036). The increase of hemoglobin was significantly higher in the 400 U/kg group (22.3±2.0 g/l) than in the 200 U/kg group (14.1±2.7 g/l) (p = 0.017). Conclusion: The r–HuEPO dose of 400 U/kg appears significantly more effective than the 200 U/kg to stimulate erythropoiesis in anemic sideropenic cancer patients.

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Autologous blood transfusion with recombinant human erythropoietin in heart operations

Cited by 69 publications

References 8 publications

Erythropoietic activity and iron metabolism in autologous blood donors during recombinant human erythropoietin therapy

Erythropoietic activity and iron metabolism in autologous blood donors during recombinant human erythropoietin therapy

Effect of Recombinant Human Erythropoietin on Transfusion Risk in Coronary Bypass Patients

Erythropoiesis after Therapy with Recombinant Human Erythropoietin: A Dose–Response Study in Anemic Cancer Surgery Patients

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Autologous blood transfusion with recombinant human erythropoietin in heart operations

Cited by 69 publications

References 8 publications

Erythropoietic activity and iron metabolism in autologous blood donors during recombinant human erythropoietin therapy

Erythropoietic activity and iron metabolism in autologous blood donors during recombinant human erythropoietin therapy

Effect of Recombinant Human Erythropoietin on Transfusion Risk in Coronary Bypass Patients

Erythropoiesis after Therapy with Recombinant Human Erythropoietin: A Dose&ndash;Response Study in Anemic Cancer Surgery Patients

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Erythropoiesis after Therapy with Recombinant Human Erythropoietin: A Dose–Response Study in Anemic Cancer Surgery Patients