Efficacy of preoperative recombinant human erythropoietin administration for reducing transfusion requirements in patients undergoing surgery for hip fracture repair. An observational cohort study.
BACKGROUND
Preoperative anaemia is a major risk factor for allogeneic blood transfusion (ABT) in patients undergoing hip fracture repair. We investigated the efficacy of preoperative recombinant human erythropoietin (rHuEPO) administration for reducing ABT requirements in a series of consecutive hip fracture patients presenting with haemoglobin (Hb) between 10 g/dl and 13 g/dl.


METHODS
The blood conservation protocol consisted of the application of a restrictive transfusion trigger (Hb < 8 g/dl) and the perioperative administration of intravenous iron sucrose (3 x 200 mg/48 h) (group 1, n = 115). Additionally, some patients received preoperative rHuEPO (40 000 IU sc) on admission to the orthopaedic ward (group 2, n = 81).


RESULTS
Overall, 103 of 196 patients (52.5%) received at least one ABT unit (2.1 +/- 1.0 U/patient). However, there were significant differences in perioperative ABT rates between groups (60% vs. 42%, for groups 1 and 2, respectively; P = 0.013). Postoperative Hb on postoperative days 7 and 30 was higher in group 2 than in group 1. In addition, in group 2, Hb levels were higher on postoperative day 30 than on admission (12.7 +/- 1.0 g/dl vs. 11.9 +/- 0.8 g/dl, respectively; P = 0.030). Administration of rHuEPO did not increase postoperative complications or 30-day mortality rate. Only three mild intravenous iron adverse effects were witnessed.


CONCLUSIONS
In anaemic hip fracture patients managed with perioperative intravenous iron and restrictive transfusion protocol, preoperative administration of rHuEPO is associated with reduced ABT requirements. However, appropriate training, education and awareness are needed to avoid protocol violations and to limit further exposure to ABT and ABT-related risks.
García-Erce
J A
JA
Departments of Haematology, University Hospital Miguel Servet, Zaragoza, Spain.
Cuenca
J
J
Haman-Alcober
S
S
Martínez
A A
AA
Herrera
A
A
Muñoz
M
M
D000368:Aged; D000369:Aged, 80 and over; D001205:Ascorbic Acid / Q000627:therapeutic use; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005290:Ferric Compounds / Q000627:therapeutic use; D000077605:Ferric Oxide, Saccharated; D005492:Folic Acid / Q000627:therapeutic use; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data*; D005937:Glucaric Acid; D019983:Guideline Adherence; D006620:Hip Fractures / Q000601:surgery*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011292:Premedication; D011446:Prospective Studies; D011994:Recombinant Proteins; D012189:Retrospective Studies; D014805:Vitamin B 12 / Q000627:therapeutic use
D005290:Ferric Compounds; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa; D005492:Folic Acid; D000077605:Ferric Oxide, Saccharated; D014805:Vitamin B 12; D001205:Ascorbic Acid; D005937:Glucaric Acid