The effect of recombinant human erythropoietin on the efficacy of autologous blood donation in patients with low hematocrits: a multicenter, randomized, double‐blind, controlled trial

Price, Thomas H.; Goodnough, Lawrence T.; Vogler, William R.; Sacher, Ronald A.; Hellman, Richard; Johnston, Marilyn F. M.; Bolgiano, Doug; Abels, Robert I.

doi:10.1046/j.1537-2995.1996.36196190512.x

Cited by 92 publications

(44 citation statements)

References 25 publications

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“…The total recommended rHuEPO dose for ABD support is 3,600 IU/kg [31, 70,82]. Our results show, however, that equally satisfactory results are obtained with lower doses: Group 2 received a total of around 1,900 IU/kg and group 3 received 2,800 IU/kg.…”

Section: Discussionmentioning

confidence: 70%

“…Our results suggest that surgery in these patients can be carried out without recurring to transfusion, when the patient's haemoglobin levels on the day of surgery are greater than 13 g/dl. This type of surgery would be equivalent to other orthopaedic techniques [6,22,24,30,70]. With rHuEPO administration, the required haemoglobin levels can be attained quickly and safely.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, ABD may involve certain problems inherent to the process, such as anaemia or adverse reactions on the part of the patient during donation, wastage of blood units due to delayed surgery, or clerical errors in blood labelling and storage [1,4,38,74,84]. Moreover, in certain circumstances it may be difficult to collect sufficient blood to cover the estimated loss during surgery [7,17,41,43,48,70].…”

Section: Role Of Rhuepo In Preoperative Autologous Blood Donationmentioning

confidence: 99%

“…This technique has been applied in orthopaedic surgery in which the typical bleeding risk is around 30% of the total blood volume [24,30,33,70,82]. The characteristics of this type of surgery are similar to those of lumbosacral procedures.…”

Section: Role Of Preoperative Rhuepo In Elective Surgery As the Only mentioning

confidence: 99%

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Preoperative erythropoietin in spine surgery

et al. 2004

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IntroductionSurgery for spinal deformities or degenerative lumbar disease may be associated with blood loss ranging from 30% to 100% of the patient's total blood volume [18, 26,68,79,85,87]. This loss of blood is related to the complexity of the procedure, duration of surgery, number of fused levels, anaesthetic technique and the patient's comorbid conditions [18, 26,68,76,79,85,87]. Extensive bleeding may lead to rapid fatal consequences and to risks associated with allogenic blood transfusion [4, 8, 36,40,81]. Measures should be taken to minimise these risks [18, 26,50,58,64,65,66,68,79].Over the last 30 years, considerable efforts have been made to develop new blood-conservation strategies that Abstract Spine surgery may be associated with profuse intraoperative bleeding that often requires blood transfusions. In recent years several techniques have been developed to avoid allogenic transfusions and their potential complications to surgical patients. In this study we review and analyse the role of preoperative recombinant human erythropoietin (rHuEPO) administration in spine surgery as a blood conservation strategy. Between 1998 and 2002, a total of 250 patients scheduled for spine surgery were included in our bloodsparing program: 114 patients (group 1), operated on before rHuEPO approval (2000), underwent preoperative autologous blood donation (ABD) alone, and 136 patients operated on after rHuEPO approval (groups 2 and 3) received rHuEPO while undergoing ABD. Adding rHuEPO to ABD resulted in higher haemoglobin and haematocrit values the day of surgery, more ABD units retrieved per patient and, consequently, reduced allogenic transfusion requirements. The effectiveness of rHuEPO as the only preoperative blood conservation technique was evaluated in ten patients with a predicted blood loss of less than 30% of their total volume, scheduled for lumbar surgery. Data from these patients were matched with those from a similar group of patients who had undergone ABD. Patients receiving rHuEPO alone had higher haemoglobin levels the day of surgery than did patients in the ABD program. Neither group required allogenic transfusions. Conclusions: preoperative rHuEPO is useful for reducing allogenic blood requirements in elective spine surgery. In patients with an expected blood loss of around 50% of blood volume, rHuEPO improves ABD, minimising preoperative anaemia and increasing the number of ABD units collected. In patients with expected blood loss below 30% of total volume, rHuEPO administration may replace ABD.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Role Of Rhuepo In Preoperative Autologous Blood Donationmentioning

confidence: 99%

Section: Role Of Preoperative Rhuepo In Elective Surgery As the Only mentioning

confidence: 99%

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Preoperative erythropoietin in spine surgery

et al. 2004

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“…7,8 Furthermore, the degree to which erythropoiesis is stimulated is not dependent on the level of storage iron present. 9 This suggests that iron is not a limiting factor for haemoglobin recovery after acute blood loss in iron-replete individuals.…”

Section: Discussionmentioning

confidence: 99%

Iron Supplementation for Postoperative Anaemia Following Major Paediatric Orthopaedic Surgery

Lau

Utukuri

Ramachandran

et al. 2007

annals

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Ann R Coll Surg Engl 2007; 89: 44-46 44Postoperative anaemia secondary to haemorrhage is a common complication following major surgery. Transfusion is best avoided particularly in children, due to the risks of infection, immunosuppression, and allo-immunisation, and is reserved for patients with severe anaemia. 1 Strategies that have been developed to reduce the severity of anaemia and minimise exposure to allogeneic blood transfusion include the use of erythropoietin, intra-operative cell salvage and autologous blood donation. 2Moderate anaemia following surgery is commonly treated empirically with iron.There has been an improved understanding of the pathophysiology and the role of iron in postoperative anaemia in the past decade. There is now strong evidence that the anaemia of surgery is not iron deficient and does not respond to iron supplementation. 3,4 Oral iron is generally safe but there are dose-dependent side-effects, particularly in children. 5 As it has been shown to be ineffective, its use cannot be recommended. Nevertheless, iron supplementation continues to be used in postoperative anaemia in various departments, including our own. This prompted us to undertake a national telephone survey of major paediatric orthopaedic surgical units in the UK to investigate the management of postoperative anaemia. Materials and MethodsWe conducted a telephone survey of the use of iron supplementation, blood transfusion, erythropoietin therapy and blood conservation techniques in the management of paediatric orthopaedic postoperative anaemia in the UK. Units which do not carry out major open hip, pelvis or spine surgery in children were excluded from this study. We interviewed middle-grade doctors (senior house officers and specialist registrars) and charge nurses at 23 major paediatric orthopaedic surgical centres. Using a structured questionnaire, we examined how postoperative anaemia is There is increasing evidence that the anaemia of surgery is not iron deficient and is, therefore, unresponsive to iron supplementation. Oral iron is best avoided postoperatively, particularly in children, due to its dose-dependent side effects. We undertook a national survey of major paediatric orthopaedic surgical units in the UK to investigate the current management of postoperative anaemia with particular reference to iron supplementation.

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