Preoperative Erythropoietin Administration in Patients With Prostate Cancer Undergoing Radical Prostatectomy Without Transfusion

Abstract

PurposeIn this study, we administered erythropoietin preoperatively to patients who underwent open radical prostatectomy without transfusion to increase their hemoglobin levels and investigated the efficacy of this procedure.Materials and MethodsWe evaluated 62 patients who underwent open radical prostatectomy performed by the same surgeon between June 2005 and January 2011. The 22 patients who refused transfusion were assigned to group 1; the patients who accepted transfusion were assigned to group 2. Before surgery, we administered erythropoietin beta to group 1 patients whose hemoglobin levels were <12 g/dL and retrospectively compared the clinical data of the two groups. We used the t-test and the chi-square test for statistical analysis.ResultsMean preoperative hemoglobin levels in group 1 after erythropoietin administration (14.5 g/dL) were significantly higher than those in group 2 (13.59 g/dL, p=0.003). Moreover, the difference in the mean hemoglobin levels before and after surgery for group 1 patients (3.55 g/dL) significantly exceeded that for group 2 patients (2.08 g/dL, p=0.000). Additional analysis revealed no statistically significant differences in perioperative complications between the groups.ConclusionsPreoperative erythropoietin administration increased the safety margin of hemoglobin levels, and this strategy worked sufficiently well in our experience.

Impact of Peri-Operative Anemia and Blood Transfusions in Patients with Gastric Cancer Receiving Gastrectomy

“…Indeed, accumulating evidence proved that excess blood transfusion during surgery might not improve but even aggravated the prognosis and increased post-operative complications, especially in curative surgery for malignancies (Meng et al, 2013;Aquina et al, 2015;Diaz-Cambronero et al, 2015;Li et al, 2015;Prescott et al, 2015). Hence, oncologic surgeries without blood transfusion were developed without increased post-operative complications by means of replacement fluid administration, autologous blood infusion, parenteral iron supplement and the use of erythropoietic-stimulating agents (Lee et al, 2014;Borstlap et al, 2015;Diaz-Cambronero et al, 2015;Inoue et al, 2015). Recently, it was reported that such novel methods for blood preservation could be practical in oncologic surgeries, particularly for the selected populations such as patients with uncommon blood types or multiple RBC allo-antibodies, as well as Jehovah's Witnesses.…”

Mortality and morbidity in non‐transfusable and transfusable patients: A systematic review and meta‐analysis

“…Data were available on renal complications from 13 studies, 18,22–25,29,35,37,38,42,44,50,52 with all studies reporting no statistically significant differences between groups. Seven studies of moderate risk of bias were included in the meta‐analysis for renal complications 18,24,25,29,38,42,52 .…”

“…We collected information on the individual PBM strategies applied to manage anemia, bleeding, and coagulopathy (Table S5 to S7, Data S1). Of the 41 studies included, 26 described the application of strategies to manage anemia, 14,18,19,21,[24][25][26][27][28]30,[32][33][34][35][36][37][38][39][43][44][45]47,49,50,53,54 with a median of two strategies applied per study; 23 studies described the application of strategies to minimize bleeding, 14,[17][18][19][20][24][25][26][27][28][29][30]33,37,38,40,43,44,[47][48][49]52,…”

“…The most common clinical setting studied was cardiac surgery (n = 16), 14,18,22,25,29,34,37,38,42-45,48-50,52 followed by orthopedic surgery (n = 8) 17,20,27,28,33,40,53,54 and urology (n = 4). 16,26,31,35 Other disciplines included in our systematic review were obstetrics and gynecology, hematology, critical care, internal medicine, cardiology, and trauma. Non-transfusable patients had more comorbidities, and were more likely to be female.…”

Outcomes of perioperative management in Jehovah's Witness patients undergoing surgeries with a risk of bleeding: a retrospective, single-center, observational study

“…Various perioperative BCSs can be used to minimize blood loss, optimize anemia tolerance, enhance hemoglobin and red blood cell production, correct coagulation defects, and promote hemostasis. These BCSs include the administration of erythropoietin, prothrombin complex concentrate, oral or intravenous iron preparations, and antifibrinolytics; preoperative autologous donation; acute normovolemic hemodilution; autologous blood transfusion after cell salvage; and use of various anesthetic techniques, such as intraoperative induction of mild hypothermia and application of permissive hypotension [14][15][16][28][29][30]. Many studies have shown that patients who refuse blood transfusion, such as JWs, can safely undergo surgery with the application of aggressive BCSs [16,[31][32][33].…”