Recombinant Human Erythropoietin and Hemoglobin Concentration at Operation and during the Postoperative Period: Reduced Need for Blood Transfusions in Patients Undergoing Colorectal Surgery—Prospective Double‐blind Placebo‐controlled Study

Abstract

In a double-blind placebo-controlled study we investigated the effect of recombinant human erythropoietin (r-HuEPO), on the perioperative hemoglobin concentration and the use of blood transfusions in patients undergoing elective colorectal surgery with a preoperative hemoglobin level </=8.5 mmol/L. Altogether 100 were included, and 81 patients could be evaluated. A total of 38 patients received r-HuEPO in a dose of 300 IU/kg body weight on day 4 before surgery and 150 IU/kg daily for the following 7 days; 43 patients received placebo. In addition, all patients received daily doses of 200 mg iron orally for 4 days before surgery. There were no differences between the two groups with regard to sex, height, weight, serum electrolytes, and liver function tests at study entry. The preentry hemoglobin concentration was similar in the two groups, with a median value of 7.9 (range 5.3-8.5) mmol/L in the erythropoietin group and 7.6 (5.1-8.5) mmol/L in the placebo group. On the day of surgery the median hemoglobin concentration was 7.8 (5. 3-9.2) mmol/L in the erythropoietin group and 7.2 (4.6-8.5) mmol/L in the placebo group (p < 0.05). On postoperative days 3 and 7 the values were 7.2 (5.3-8.2) and 7.5 (5.4-9.4) mmol/L, respectively, in the erythropoietin group compared to 6.7 (5.2-7.8) and 6.9 (5.1-8.6) mmol/L in the placebo group (p < 0.01). At discharge the hemoglobin concentration was 7.8 (5.9-8.8) mmol/L in the erythropoietin group and 7.2 (5.4-8.6) mmol/L in the placebo group (p < 0.002). The blood loss during operation was similar in the two groups. In the erythropoietin group the median value was 280 ml (range 25-2000 ml), with the lower and upper quartiles 150 and 500 ml, respectively. In the placebo group the blood loss was median 300 ml (range 50-1800 ml), with the lower and upper quartiles 200 and 750 ml, respectively. The number of blood transfusions given was significantly lower in the erythropoietin group, with a mean of 0.3 (range 0-6) units compared to 1.6 (0-9) units in the control group (p < 0.05). In conclusion, the hemoglobin concentration at the time of surgery and during the week following surgery was significantly higher in the group of patients receiving r-HuEPO perioperatively compared to the placebo group together with a significant lower use of blood transfusions in the r-HuEPO group. However, the clinical implications of these findings has yet to be proven.

Effect of Darbepoetin Alfa on Physical Function in Patients Undergoing Surgery for Colorectal Cancer

“…In this study, perioperative DA treatment improved postoperative work capacity, but had no effect on fatigue, QoL or postural sway in patients with colorectal cancer undergoing elective surgery. Treatment with DA significantly increased median Hb concentration perioperatively compared with placebo, as has been shown in other studies [15, 16, 24, 25]. …”

“…Treatment with recombinant human erythropoietin has been shown to reduce the postoperative blood transfusion requirement compared with placebo in some studies [15, 16, 36]. For example, in the study by Qvist et al [15] the median blood loss during surgery was 280 ml in patients treated with erythropoietin and 300 ml in the placebo group.…”

“…Treatment with erythropoietin has been shown to increase hemoglobin (Hb) concentrations in the postoperative period and to reduce the need for blood transfusions in patients undergoing colonic resection [15] and surgery for cancer in the gastrointestinal tract [16]. However, the effect of erythropoietin treatment on postoperative rehabilitation has not been assessed.…”

Blood Transfusion Practices in Major Orthopaedic Surgery

“…The effect of EPO in minimizing exposure to allogeneic blood compared to placebo has been studied in patients undergoing orthopaedic (Faris 1998;Laupacis 1998), cardiac and colonic cancer surgery (Kettelhack 1998;Qvist 1999). In excess of 1000 patients were randomized and an overall significant reduction in allogeneic transfusion occurred in orthopaedic patients.…”

Anemia and Blood Transfusion in the Critically Ill:The Role of Erythropoietin

“…In general, these studies have shown a significant increase in erythropoietic activity associated with EPO therapy, with or without a significant difference in the frequency of allogeneic transfusions. [28][29][30] Similarly, EPO has been studied in patients undergoing cardiac surgery. In a randomized controlled trial of 76 elective open-heart surgical patients, the use of EPO during a 14-day preoperative period was associated with a significantly increased hematocrit, compared with placebo.…”