Single, high-dose erythropoietin given two days pre-op reduces need for transfused blood

May 6, 2013

Anemia increases operative mortality and morbidity in non-cardiac and cardiac surgical procedures. Anemic surgical patients may require more blood transfusions, raising the risk of transfusion-related complications and increasing costs. For those reasons, optimizing patient readiness by correcting anemia prior to surgery is an important clinical goal. A simple new protocol has been proposed that helps correcting anemia using a single, high dose of recombinant human erythropoietin (HRE) administered only two days prior to surgery. The results of a randomized study will be presented by Luca Weltert, MD, Cardiac Surgery Department of the European Hospital in Rome, during the Plenary Scientific Session of the 93rd AATS Annual Meeting in Minneapolis.

HRE, a growth factor, can offset anemia, but previous protocols required that HRE must be given many days or even weeks before surgery following a complicated dosage regimen. Practically, patients often do not have that much time for preparation, and sometimes surgery must be delayed, increasing hospital costs.

In this single-blind randomized study of 600 patients presenting for , 300 patients received a single dose of HRE 80,000 UI as a bolus two days prior to surgery and 300 patients served as controls. The results showed that prior administration of HRE reduced transfusion requirements by about one third, from a mean of 1.12 blood units per patient to 0.39 blood units per patient (p<0.001). In the control group, 39% of patients required a transfusion, compared to 17% of those who received HRE. Mean hemoglobin levels on postop day 4 were significantly higher in the HRE group (9.02 vs. 10.21 g/dl, p=0.02). No differences between groups were found for mortality or adverse events.

The HRE protocol also resulted in cost savings, according to Dr. Weltert. Taking into account the costs of HRE, the cost of a (blood and labor costs), and the savings from avoiding blood transfusions, Dr. Weltert found that the HRE protocol was cost-effective.

"HRE therapy remains a viable, yet underused option, a milestone in the 'bloodless story.' In the past its role was predominantly in association with preoperative autologous blood donation, while in the present its role has to be focused on the management of perioperative anemia," says Dr. Weltert.

Explore further: Researchers say it's time to treat anemia seriously

More information: "Single High Dose of Erythropoietin Two Days Before Surgery: A Simplified Short Term Approach to Blood Spare," by Luca Weltert, MD, Beatrice Rondinelli, MD, Mauro Falco, MD, Alessandro Bellisario, MD, Daniele Maselli, MD, Luca Pierelli, MD, and Ruggero De Paulis, MD. Presentation at the 93rd AATS Annual Meeting. May 4-8, 2013. Minneapolis, MN, during the Plenary Scientific Session on May 6, 8:45 AM CT. aats.org/annualmeeting/

Related Stories

Researchers say it's time to treat anemia seriously

January 24, 2013
Up to one-third of patients undergoing surgery in Ontario have a treatable form of anemia but are not optimally treated for it.

Severe anemia linked to poorer heart surgery outcomes

October 3, 2012
(HealthDay)—Adults undergoing cardiac surgery who have moderate-to-severe preoperative anemia have significantly increased morbidity and mortality compared with non-severely anemic patients, according to research published ...

Study examines outcomes of patients who refuse transfusion following cardiac surgery

July 2, 2012
Jehovah's Witness patients who undergo cardiac surgery do not appear to be at increased risk for surgical complications or death when compared to patients who undergo cardiac surgery and receive blood transfusions, according ...

Recommended for you

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

Researchers discover indicator of lung transplant rejection

July 13, 2017
Research by scientists at Dignity Health St. Joseph's Hospital and Medical Center's Norton Thoracic Institute was published in the July 12, 2017 issue of Science Translational Medicine titled "Zbtb7a induction in alveolar ...

New device could make closing surgical incisions a cinch

July 7, 2017
Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including ...

Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017
Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.