title: Perisurgical erythropoietin application in anemic patients with colorectal cancer: A double-blind randomized study.
abstract: BACKGROUND
  Blood transfusions are associated with higher postoperative morbidity and tumor recurrence rates in colorectal cancer surgery, To reduce the need for transfusions in patients with tumor-induced anemia who are not suitable for autologous blood donation, it was tested whether perisurgical erythropoietin application would be able to stimulate hematopoiesis adequately.
  
  
  METHODS
  In a double-blind randomized study 150 IU/kg body weight erythropoietin was given subcutaneously every 2 days beginning 10 days before operation and continuing until postoperative day 2. Twenty patients were randomized into the erythropoietin group with three observed dropouts and 10 patients into the placebo group.
  
  
  RESULTS
  In the erythropoietin group two episodes of hypertension and one deep venous thrombosis were observed. Preoperative hemoglobin response in the erythropoietin group (p = 0.069) was paralleled by a highly significant reticulocyte increase (p = 0.0004). However, frequency of blood transfusion was not different between both study groups (erythropoietin, 1.82 +/- 0.80 units/ patient; placebo, 1.80 +/- 0.97 units/patient). If iron availability was analyzed, a strong correlation between ferritin blood levels and transferrin iron saturation with hemoglobin response was observed in regression analysis (p < 0.001).
  
  
  CONCLUSIONS
  These results indicate that hematopoiesis in anemic patients with colorectal cancer can be stimulated by erythropoietin; however, clinical efficacy is to be expected only in selected patients with high iron availability, which calls for further studies combining erythropoietin and parenteral iron application.
authors.affiliation: Department of Surgery, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany.
authors.forename: M M
authors.initials: MM
authors.lastname: Heiss
authors.forename: A
authors.initials: A
authors.lastname: Tarabichi
authors.forename: C
authors.initials: C
authors.lastname: Delanoff
authors.forename: H
authors.initials: H
authors.lastname: Allgayer
authors.forename: K W
authors.initials: KW
authors.lastname: Jauch
authors.forename: T
authors.initials: T
authors.lastname: Hernandez-Richter
authors.forename: W
authors.initials: W
authors.lastname: Mempel
authors.forename: K G
authors.initials: KG
authors.lastname: Beck
authors.forename: F W
authors.initials: FW
authors.lastname: Schildberg
authors.forename: K
authors.initials: K
authors.lastname: Messmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D015179:Colorectal Neoplasms / Q000150:complications*; D004311:Double-Blind Method; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007279:Injections, Subcutaneous; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D014168:Transferrin / Q000032:analysis
chemical_list: D006454:Hemoglobins; D014168:Transferrin; D004921:Erythropoietin; D005293:Ferritins