Erythropoiesis, erythropoietin, and iron metabolism in elective surgery: preoperative strategies for avoiding allogeneic blood exposure.
Preoperative autologous donation (PAD) of blood and administration of recombinant human erythropoietin (Epoetin alfa) are two strategies for increasing red blood cell (RBC) mass preoperatively. The success of PAD depends primarily on the patient's ability to manufacture new RBCs before surgery to replace those removed during PAD. Red blood cell manufacture depends in turn on adequate supplies of iron and the increased renal production of endogenous erythropoietin following PAD. Successful PAD also requires adequate time for regeneration of predonated RBCs. Parenteral administration of Epoetin alfa causes a dose-dependent stimulation of RBC production. Its use has been studied as an adjunct to PAD and as a method to enhance endogenous erythropoiesis without PAD. Several studies suggest that administration of Epoetin alfa, begun several days before surgery, may stimulate erythropoiesis and help decrease the number of RBC transfusions required postoperatively. The precise role of Epoetin alfa in the surgical setting is not yet established, and optimal dosage regimens have not been determined.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
M A
MA
Goldberg
D000368:Aged; D000740:Anemia / Q000517:prevention & control*; D001804:Blood Transfusion, Autologous; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D017707:Erythrocyte Transfusion; D004920:Erythropoiesis / Q000187:drug effects* / Q000502:physiology; D004921:Erythropoietin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007249:Inflammation / Q000503:physiopathology; D008297:Male; D010003:Osteoarthritis / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000493:pharmacokinetics
D011994:Recombinant Proteins; D004921:Erythropoietin; D005293:Ferritins