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Two injections of erythropoietin correct moderate anemia in most patients awaiting orthopedic surgery

[Deux injections d’érythropoïétine corrigent une anémie modérée chez la plupart des patients en attente d’une opération orthopédique]

Nadia Rosencher, MD^*, Dominique Poisson, MD, Aline Albi, MD^*, Martine Aperce, MD, Jeanne Barré, MD and Charles Marc Samama, MD PhD^¶

^* From the Departments of Anesthesia, Paris M5 University - Cochin Hospital,
Bichat University Hospital,
Poitiers University Hospital,
Reims University Hospital, Paris;
^¶ Avicenne University Hospital, Bobigny, France.

Address correspondence to: Dr. Nadia Rosencher, Paris M5 University - Cochin Hospital, 27, rue du Faubourg St Jacques, 75014 Paris, France. Phone: 33 1 58 41 31 05; Fax: 33 1 58 41 14 96; E-mail: nadia.rosencher{at}cch.ap-hop-paris.fr

Background: The primary objective of this study was to assess the number of erythropoietin (EPO) injections required to reach a hematocrit (Ht) of 40% in moderately anemic patients. The secondary objective was to compare this strategy with autologous blood donation (ABD) in elective orthopedic surgery in terms of red blood cell (RBC) production.

Study design and methods: 93 patients with a baseline Ht between 30 and 39% were randomized into two groups the day of the preoperative assessment. In the EPO group, patients received 40,000 UI/week sc until they reached a maximal Ht of 40%. In the ABD group, a RBC pack was collected every week as long as the Ht was above 33%.

Results: Two EPO injections were necessary to reach a 40% Ht in 63% of the patients. It was possible to collect two RBC packs in 45% of the patients in the ABD group. Volume of RBC production was significantly higher in the EPO group: 268 ± 142 mL vs 141 ± 129 (P = 0.0001). In the EPO group, Ht was significantly higher on days one and three after surgery and at discharge. The energy score was better in the EPO group. In the ABD group, 12.6% patients vs 6.5% in the EPO group received allogeneic transfusion (ns).

Conclusion: Only two EPO injections were sufficient to reach a Ht of 40% in the majority of patients. Therefore, to improve cost/effectiveness, the number of EPO injections should be related to baseline Ht instead of the four injections recommended in the product monograph.

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