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A study presented in the November 2011 issue of Anesthesiology has discovered that administration of a single intravenous dose of erythropoietin, plus iron supplement, one day before surgery, significantly reduced blood transfusion requirements in anemic patients undergoing valvular heart surgery.
The fact that a single intravenous dose of erythropoietin (a glycoprotein hormone that controls red blood cell production) could improve blood conservation is an exciting prospect because blood transfusion during and after surgery is costly and carries some risks.
“Blood transfusion has been associated with adverse outcomes related to kidney injury, neurologic complications, atrial fibrillation, and acute lung injury,” said lead researcher Young-Lan Kwak, M.D., Ph.D. “Thus, the importance of blood conservation strategies to minimize transfusion is being increasingly emphasized, especially since donated blood is such a precious commodity with unpredictable availability.”
Dr. Kwak, a professor in the Severance Biomedical Science Institute, Yonsei University Health System, Seoul, South Korea, said that erythropoietin has been developed to treat anemia caused by reduced red blood cell production resulting from kidney and blood diseases.
However, a conventional regimen of erythropoietin therapy is expensive and requires at least four days of hospitalization before surgery, and repeated injections are given during the procedure.
Dr. Kwak and his research team wanted to focus on a single-dose therapy that targeted the effects of inflammatory responses caused by anesthesia and cardiac surgical procedures.
“By targeting the erythropoietin therapy on mitigating the inflammatory response caused by surgical procedures that reduce blood cell production, we hypothesized that a single intravenous administration could reduce transfusion requirements in anemic patients undergoing cardiac surgery,” said Dr. Kwak.
The study involved 74 patients with preoperative anemia who were undergoing valvular heart surgery. One group was given the single dose of erythropoietin with an iron supplement, and the other group was given a placebo of saline solution. Transfusion was required in 86 percent of the saline group, but in only 59 percent of the erythropoietin group.
“Impressively, only a single patient required transfusion after the day of the operation in the erythropoietin group, while several patients were repeatedly transfused during the postoperative period in the saline group,” said Dr. Kwak. “Although further study certainly is required, we observed a significant reduction in transfusion requirements without any side effects. Thus far, our study showed this simple regimen to be safe and effective.”
For more information, visit the Anesthesiology website at www.anesthesiology.org.
