Epoetin in the 'untransfusable' anaemic patient: a retrospective case series and systematic analysis of literature case reports.
BACKGROUND
Erythropoiesis stimulating agents [erythropoietin (EPO)] have been recommended to treat anaemic patients who cannot receive or refuse blood tranfusion ('untransfusable' patients).


OBJECTIVE
The objective of the study was to quantify the association of EPO use with haemoglobin (Hgb) recovery in anaemic untransfusable hospitalised patients.


METHODS
EPO treated anaemic untransfusable patients were identified through the combination of a retrospective case review and a systematic review of the medical literature. Literature reports of untransfusable patients not treated with any EPO were used as a comparator group. Hgb concentrations before and following EPO use were abstracted and used to determine the rate of Hgb recovery for each case. Multilevel mixed effects modelling was used to determine the association of Hgb recovery with EPO use.


RESULTS
A total of 76 EPO treated cases (19 cases from the retrospective hospital case review and 57 from the literature), and 33 non-EPO treated comparator patients from the literature were included in the study. Hgb increased similarly over time in all groups at an overall mean standard error (SE) rate of 0·13 (0·01) g dL(-1)  day(-1) . The Hgb recovery rate was higher in patients with lower baseline Hgb, regardless of EPO use. No association was found between the rate of Hgb recovery and EPO use, dose or therapy duration.


CONCLUSIONS
In anaemic, 'untransfusable' hospitalised patients, EPO use was not associated with increased Hgb recovery at anytime within 28 days.
Department of Pharmacy, St. Joseph's Hospital Medical Center, Syracuse, New York, USA.
A M
AM
Heh-Foster
M
M
Naber
M P
MP
Pai
T S
TS
Lesar
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood* / Q000188:drug therapy*; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011994:Recombinant Proteins / Q000627:therapeutic use; D020127:Recovery of Function; D012189:Retrospective Studies
D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa
Jehovah's Witness; epoetin; erythropoetin; haemoglobin; transfusion