[Cardiac surgery without homologous blood transfusion--the effectiveness and the indication of recombinant human erythropoietin].
In 376 patients who underwent cardiovascular surgery using extracorporeal circulation between May 1989 and December 1991, we assessed the effectiveness of recombinant human erythropoietin (rHuEPO) and the indications for its use. A total of 174 patients received rHuEPO, which was administered intravenously (100 U/kg/day) or subcutaneously (400-600 U/kg/week). Of 348 elective surgeries, the operation was routine in 335 and was expected to require massive blood transfusion, such as reoperation and aortic surgery, in 13. The former group was divided into two subgroups, i.e., 292 patients with a hemoglobin of 12 g/dl or higher and 43 patients with hemoglobin levels under 12 g/dl. In the former subgroup, the rate of patients not receiving homologous blood transfusion was 96.3% following autologous donation with rHuEPO and 91.4% following autologous frozen blood donation for prolonged preservation period without rHuEPO. In contrast, even in the same subgroup, the rate was 82.5% for the patients who donated autologous liquid stored blood for a short time without rHuEPO. In the latter subgroup, the rate was 80.6% when rHuEPO was administered, and it was significantly higher than the rate of 25% in patients not receiving rHuEPO (p < 0.01). The rate increased to 91.3% when the anemia improved and autologous blood could be donated preoperatively. Autologous blood transfusion is generally not considered for patients undergoing reoperation and aortic surgery. In 70.0% of such patients, however, the operation could be completed without homologous blood transfusion when rHuEPO was administered and about 2000 ml of autologous blood was available. Subcutaneous use of rHuEPO was as effective as intravenous use.(ABSTRACT TRUNCATED AT 250 WORDS)
Watanabe
Y
Y
Division of Cardiovascular Surgery, Toranomon Hospital, Tokyo, Japan.
Fuse
K
K
Naruse
Y
Y
Kobayashi
T
T
Yamamoto
S
S
Konishi
H
H
Horii
T
T
D000368:Aged; D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use
D011994:Recombinant Proteins; D004921:Erythropoietin