Preoperative Administration of Recombinant Human Erythropoietin in Patients Undergoing Gynecologic Surgery

Abstract

The effect of preoperative recombinant human erythropoietin (r-HuEPO) in anemic women undergoing gynecologic surgery for benign diseases was evaluated in this prospective, not randomized study. One hundred and twenty women were included in the study. Sixty women were treated preoperatively with r-HuEPO at three different cumulative doses: 80,000, 120,000 and 160,000 IU. Sixty nonanemic women were not treated. Baseline hemoglobin (Hb) levels were measured. Hb levels were also measured on the day of the surgery before starting the procedure, on postoperative day 1 and on the day of discharge from the hospital. Treatment with r-HuEPO significantly increased both preoperative Hb levels and Hb levels at discharge. Conversely, Hb levels at discharge were lower than baseline levels in untreated women. The effect of r-HuEPO on Hb levels was exerted in a dose-dependent fashion. No adverse and/or side effects of treatment were observed. Preoperative treatment with r-HuEPO in selected anemic patients undergoing gynecologic surgery for benign diseases seems to be a safe and useful tool to reduce the need for red blood cell transfusions.

Uterine myomas: management

“…No side effects were experienced. A prospective, nonrandomized study of preoperative epoetin found a significant increase in hemoglobin concentrations before, and after, gynecologic surgery (61).…”

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“…Epoetin beta has shown similar effects in patients with colon cancer [37]. Other patient groups for whom surgery is indicated and in whom preoperative rHuEPO exerts beneficial effects include those with prostate cancer [38], head and neck cancer [39], and women undergoing gynecologic surgery for benign conditions [40]. …”

Bloodless Surgery in a Jehovah’s Witness Patient with a 12.7-kg Uterine Leiomyosarcoma

“…2 Several studies demonstrate the feasibility and application of preoperative measures (eg, erythropoietin administration) or intraoperative measures (eg, cell salvage) in patients undergoing gynecologic surgery desiring to avoid allogeneic transfusions. [3][4][5][6] This case demonstrates the successful implementation of a comprehensive bloodless surgery protocol in caring for a patient with a massive uterine leiomyosarcoma.…”

“…Preoperative erythropoietin is used in both weekly and daily regimens, and several reports support its use in patients undergoing gynecologic surgery. 3,4,8 Preoperative patients should receive appropriate iron supplementation (oral or intravenous) during treatment. 8 Oral iron is effective 3 ; however, if needed as in the case of this patient with poor oral intake, intravenous iron is recommended to be administered at 1-to 2-week intervals.…”