The Journal of Bone and Joint Surgery 78:62-72 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.
The Effects of Recombinant Human Erythropoietin on Perioperative Transfusion Requirements in Patients Having a Major Orthopaedic Operation*
P. M. FARIS, M.D. ,
M. A. RITTER, M.D.,
R. I. ABELS, M.D. , MOORESVILLE, INDIANA and
AND THE AMERICAN ERYTHROPOIETIN STUDY GROUP
Investigation performed at The Center for Hip and Knee Surgery, Mooresville
Two hundred patients who were scheduled for a major elective orthopaedic operation were enrolled in a prospective study and were randomly assigned to one of three treatment groups. Group 1 consisted of sixty patients who received recombinant human erythropoietin, 300 international units per kilogram of body weight per day; Group 2, seventy-one patients who received recombinant human erythropoietin, 100 international units per kilogram of body weight per day; and Group 3, sixty-nine patients who received a placebo. A total of fifteen doses was given subcutaneously, beginning ten days before the operation and extending through the fourth postoperative day. Patients who declined or were unable to donate autologous blood preoperatively were included in the study and were maintained on iron supplementation orally. The decision to transfuse red blood cells depended on the physician; however, physicians were encouraged not to do so if the hematocrit was more than 0.27 (27 per cent), unless the clinical symptoms warranted it.
Of the 185 patients who were evaluable with regard to efficacy, significantly fewer patients received homologous red-blood-cell transfusions in Groups 1 and 2 (17 per cent [nine] and 25 per cent [sixteen], respectively) than in Group 3 (54 per cent [thirty-six]) (p < 0.001). When the patients were stratified into two groups on the basis of the pre-treatment hemoglobin level (more than 100 to 130 grams per liter or more than 130 grams per liter), we found that patients who had received a placebo and had a baseline hemoglobin level of more than 100 to 130 grams per liter were at significantly higher risk for transfusion (78 per cent [twenty-one]) than those who had received a placebo and had a baseline level of more than 130 grams per liter (36 per cent [fourteen]). For patients who had a baseline hemoglobin level of more than 100 to 130 grams per liter, the higher dose of recombinant human erythropoietin appeared somewhat more effective than the lower dose, with 14 per cent (three) of the patients in Group 1 and 39 per cent (nine) in Group 2 needing a transfusion; however, the difference was not significant (p = 0.09). For patients who had a baseline hemoglobin level of more than 130 grams per liter, the two doses of recombinant human erythropoietin produced similar results, with 14 per cent (four) of the patients in Group 1 and 11 per cent (four) in Group 2 needing a transfusion; this was in contrast to a rate of transfusion of 36 per cent (fourteen) in Group 3 (the patients who received the placebo) (p = 0.03).
The recombinant human erythropoietin was generally well tolerated, although one patient, who did not have a history of hypertension, had an increase in blood pressure, from a baseline level of 142/78 millimeters of mercury (18.93/10.40 kilopascals) to a level of 220/100 millimeters of mercury (29.33/13.33 kilopascals), after ten days of treatment with the higher dose. These data suggest that recombinant human erythropoietin, administered before and after major orthopaedic operations, can minimize the need for homologous red-blood-cell transfusion.
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
L. Bayam, W. F. Tait, and I. D. Macartney
Successful Repair of a Giant Abdominal Aortoiliac Aneurysm in a Jehovah's Witness
Vascular and Endovascular Surgery,
November 1, 2007;
41(5):
460 - 462.
[Abstract]
[PDF]
|
|
|
|
|
|
|
M. A. Fischer, C. A. Morris, W. C. Winkelmayer, and J. Avorn
Nononcologic Use of Human Recombinant Erythropoietin Therapy in Hospitalized Patients
Arch Intern Med,
April 23, 2007;
167(8):
840 - 846.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. H. Henry, P. Bowers, M. T. Romano, and R. Provenzano
Epoetin Alfa: Clinical Evolution of a Pleiotropic Cytokine
Arch Intern Med,
February 9, 2004;
164(3):
262 - 276.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Weiss
New Insights Into Erythropoietin and Epoetin Alfa: Mechanisms of Action, Target Tissues, and Clinical Applications
Oncologist,
December 1, 2003;
8(90003):
18 - 29.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. P. Bezwada, D. G. Nazarian, D. H. Henry, and R. E. Booth Jr.
Preoperative Use of Recombinant Human Erythropoietin Before Total Joint Arthroplasty
J. Bone Joint Surg. Am.,
September 1, 2003;
85(9):
1795 - 1800.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. C. Johnson, C. Chebli, and A. J. Aboulafia
Epoetin Alfa
J. Am. Acad. Ortho. Surg.,
March 1, 2003;
11(2):
77 - 80.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. L. Carson
Should Patients in Intensive Care Units Receive Erythropoietin?
JAMA,
December 11, 2002;
288(22):
2884 - 2886.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. M. Keating and J. B. Meding
Perioperative Blood Management Practices in Elective Orthopaedic Surgery
J. Am. Acad. Ortho. Surg.,
November 1, 2002;
10(6):
393 - 400.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. S Vanderlinde, J. M Heal, and N. Blumberg
Autologous transfusion
BMJ,
March 30, 2002;
324(7340):
772 - 775.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Salido, L. A. Marin, L. A. Gomez, P. Zorrilla, and C. Martinez
Preoperative Hemoglobin Levels and the Need for Transfusion After Prosthetic Hip and Knee Surgery : Analysis of Predictive Factors
J. Bone Joint Surg. Am.,
February 1, 2002;
84(2):
216 - 220.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. E. Puzas, R. J. O'Keefe, and J. R. Lieberman
The Orthopaedic Genome: What Does the Future Hold and Are We Ready?
J. Bone Joint Surg. Am.,
January 1, 2002;
84(1):
133 - 141.
[Full Text]
|
|
|
|
|
|
|
L. T. Goodnough, B. Skikne, and C. Brugnara
Erythropoietin, iron, and erythropoiesis
Blood,
August 1, 2000;
96(3):
823 - 833.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Murkin, G. M. Haig, K. J. Beer, J. McCutchen, M. E. Comunale, R. Hall, and B. B. Ruzicka
Aprotinin Decreases Exposure to Allogeneic Blood During Primary Unilateral Total Hip Replacement
J. Bone Joint Surg. Am.,
May 1, 2000;
82(5):
675 - 675.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
A. M. HATZIDAKIS, M. R. MENDLICK, T. McKILLIP, R. L. REDDY, and K. L. GARVIN
Preoperative Autologous Donation for Total Joint Arthroplasty. An Analysis of Risk Factors for Allogenic Transfusion
J. Bone Joint Surg. Am.,
January 1, 2000;
82(1):
89 - 100.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. J. Kost, S. S. Ehrmeyer, B. Chernow, J. W. Winkelman, G. P. Zaloga, R. P. Dellinger, and T. Shirey
The Laboratory-Clinical Interface: Point-of-Care Testing
Chest,
April 1, 1999;
115(4):
1140 - 1154.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. E. BIERBAUM, J. J. CALLAGHAN, J. O. GALANTE, H. E. RUBASH, R. E. TOOMS, and R. B. WELCH
An Analysis of Blood Management in Patients Having a Total Hip or Knee Arthroplasty
J. Bone Joint Surg. Am.,
January 1, 1999;
81(1):
2 - 10.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
E. M. KEATING
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Current Options and Approaches for Blood Management in Orthopaedic Surgery*{{dagger}}
J. Bone Joint Surg. Am.,
May 1, 1998;
80(5):
750 - 62.
[Full Text]
|
|
|
|
|
|
|
L. T. Goodnough, G. J. Despotis, and C. A. Parvin
Erythropoietin Therapy in Patients Undergoing Cardiac Operations
Ann. Thorac. Surg.,
December 1, 1997;
64(6):
1579 - 1580.
[Full Text]
|
|
|
|
|
|
|
M. Cazzola, F. Mercuriali, and C. Brugnara
Use of Recombinant Human Erythropoietin Outside the Setting of Uremia
Blood,
June 15, 1997;
89(12):
4248 - 4267.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. T. Goodnough, T. G. Monk, and G. L. Andriole
Erythropoietin Therapy
N. Engl. J. Med.,
March 27, 1997;
336(13):
933 - 938.
[Full Text]
[PDF]
|
|
|
|
