Erythropoiesis‐stimulating agents: friends or foes?

Shander, Aryeh; Ozawa, Sherri; Gross, Irwin; Henry, David H.

doi:10.1111/trf.12328

Cited by 10 publications

(4 citation statements)

References 40 publications

(79 reference statements)

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“… 8 The use of pediatric blood tubes should be considered when appropriate, and the judicious use of intravenous iron and erythropoietin should also be considered in the postoperative period. 8 , 11 , 13 , 14 If acute postoperative bleeding is suspected, the surgeon should consider reoperation promptly to identify and treat the source of bleeding. 8 Although we do not routinely follow hemoglobin levels in the postoperative period in a stable patient, studies have shown a low risk of postoperative mortality in upper nadir hemoglobin ranges of 7–8 g/dL and much higher risk in lower ranges.…”

Section: Discussionmentioning

confidence: 99%

Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service

Nagarsheth

Gupta²,

Gupta

et al. 2014

JBM

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ObjectivesTo review the responses of advance directives signed by Jehovah’s Witness patients prior to undergoing surgery at a gynecologic oncology service.Study designA retrospective chart review of gynecologic oncology patients undergoing surgery at a bloodless surgery center from 1998–2007 was conducted. Demographic, pathologic, and clinical data were recorded. The proportion of patients who accepted and refused various blood-derived products was determined and was compared to previously published results from a similar study of labor and delivery unit patients.ResultsNo gynecologic oncology patients agreed to accept transfusions of whole blood, red cells, white cells, platelets, or plasma under any circumstance, whereas 9.8% of pregnant patients accepted transfusion (P=0.0385). However, 98% of gynecologic oncology patients agreed to accept some blood products, including fractions such as albumin, immunoglobulins, and clotting factors, while only 39% of pregnant patients agreed (P<0.0001). In addition, all gynecologic oncology patients (100%) accepted intraoperative hemodilution, compared to 55% of pregnant patients (P<0.0001).ConclusionOur results confirm the commonly held belief that the majority of Jehovah’s Witness patients refuse to accept major blood components. However, Jehovah’s Witness patients at a gynecologic oncology service will accept a variety of blood-derived products (minor fractions) and interventions designed to optimize outcomes when undergoing transfusion-free surgery. Patients presenting to a gynecologic oncology service respond differently to advanced directives related to bloodless surgery, as compared to patients from an obstetrical service.

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Section: Discussionmentioning

confidence: 99%

Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service

Nagarsheth

Gupta²,

Gupta

et al. 2014

JBM

Self Cite

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“…Additionally, we recommend cautious use of ESAs in patients whose transfusion requirements have not decreased or who have failed to realize an increase in hemoglobin of greater than 1 g/dL after 6–8 weeks of dosing. Deleterious effects of ESAs, while originally thought to be due to increased blood viscosity (with or without subsequent platelet activation ) or agonistic effect on tumor cell epo receptors, may actually be due to unopposed circulating plasma erythropoietin . This hypothesis may help to explain reasons for increased VTE and mortality risk in patients with Hb values in the low or normal range, who received higher doses due to “targeting” a higher Hb value.…”

Section: Rbc Transfusion Versus Esasmentioning

confidence: 99%

Diagnosis and treatment of cancer‐related anemia

2014

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Cancer-related anemia (CRA) is due to multiple etiologies, including chemotherapy-induced myelosuppression, blood loss, functional iron deficiency, erythropoietin deficiency due to renal disease, marrow involvement with tumor as well as other factors. The most common treatment options for CRA include iron therapy, erythropoietic-stimulating agents (ESAs), and red cell transfusion. Safety concerns as well as restrictions and reimbursement issues surrounding ESA therapy for CRA have resulted in suboptimal treatment. Similarly, many clinicians are not familiar or comfortable using intravenous iron products to treat functional iron deficiency associated with CRA. This article summarizes our approach to treating CRA and discusses commonly encountered clinical scenarios for which current clinical guidelines do not apply.

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“…Erythropoiesis‐stimulating agents (ESAs) such as recombinant human erythropoietin increase the hemoglobin preoperatively and may be a useful adjuvant in certain situations such as a high‐risk group for bleeding (for example weight <10 kg, syndromic patient with co‐morbidities, or preoperative anemia; Hgb <10 g·dl −1 ) . ESA clinical protocols of epoetin alfa 600IU kg·week −1 subcutaneously for 3–4 weeks in divided doses, with iron, vitamin B12, vitamin E, and folic acid oral supplementation have been described.…”

Section: Blood Conservation Techniquesmentioning

confidence: 99%

Bleeding management for pediatric craniotomies and craniofacial surgery

Goobie

Haas

2014

Pediatric Anesthesia

130

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Pediatric patients when undergoing craniotomies and craniofacial surgery may potentially have significant blood loss. The amount and extent will be dictated by the nature of the surgical procedure, the proximity to major blood vessels, and the age, and weight of the patient. The goals should be to maintain hemodynamic stability and oxygen carrying capacity and to prevent and treat hyperfibrinolysis and dilutional coagulopathy. Over transfusion and transfusion-related side effects should be minimized. This article will highlight the pertinent considerations for managing massive blood loss in pediatric patients undergoing craniotomies and craniofacial surgery. North American and European guidelines for intraoperative administration of fluid and blood products will be discussed.

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Erythropoiesis‐stimulating agents: friends or foes?

Cited by 10 publications

References 40 publications

Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service

Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service

Diagnosis and treatment of cancer‐related anemia

Bleeding management for pediatric craniotomies and craniofacial surgery

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Erythropoiesis‐stimulating agents: friends or foes?

Cited by 10 publications

References 40 publications

Responses of advanced directives by Jehovah&#39;s Witnesses on a gynecologic oncology service

Responses of advanced directives by Jehovah&#39;s Witnesses on a gynecologic oncology service

Diagnosis and treatment of cancer‐related anemia

Bleeding management for pediatric craniotomies and craniofacial surgery

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Product

Resources

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Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service

Responses of advanced directives by Jehovah's Witnesses on a gynecologic oncology service