Blood conservation in neurosurgery: erythropoietin and autologous donation.
BACKGROUND
Neurosurgery may involve significant blood loss and frequently requires allogeneic red blood cell (RBC) transfusion. Preoperative recombinant erythropoietin (EPO) may be used to improve erythroid status and recovery, and used either alone or in combination with preoperative autologous donation (PAD) it may reduce exposure to allogeneic RBC. We wished to study the use of EPO with and without PAD and the risk of RBC transfusion in neurosurgery.


METHODS
Using a retrospective case-control design, 57 patients who received EPO preoperatively were matched 2:1 for age, sex, year of surgery, and International Classification of Diseases code most responsible for surgery (three were excluded because of stringent matching criteria, leaving 54 cases and 108 comparison subjects). Thirty-two cases participated in PAD. Medical and anesthetic records as well as laboratory investigations were reviewed and extracted.


RESULTS
Allogeneic RBC exposure was identical for EPO cases and comparison subjects (18.5%). Concomitant PAD and EPO did not reduce allogeneic RBC exposure (21.9%), and resulted in a greater number of RBC units transfused. Last recorded hemoglobin levels suggested that autologous RBCs were not more liberally used. Patients who engaged in PAD and EPO suffered from iatrogenic anemia. A significant proportion (58.6%) of the autologous RBCs was ultimately not used and discarded.


CONCLUSIONS
Further research is needed to determine the efficacy of EPO in neurological surgery. PAD does not appear to reduce the risk of allogeneic RBC transfusion, despite concomitant EPO. Indeed, PAD resulted in iatrogenic anemia and increased transfusion requirements. The cost-effectiveness of blood conservation efforts in neurosurgery deserves additional research.
1Injury Prevention Research,St-Michael's Hospital,University of Toronto,Toronto,ON,Canada.
Alexander
A
McGirr
3Department of Laboratory Medicine,St-Michael's Hospital and Department of Laboratory Medicine and Pathobiology,University of Toronto,Toronto,ON,Canada.
Katerina
K
Pavenski
2Department of Psychiatry,University of British Columbia,Vancouver,Canada.
Bhanu
B
Sharma
1Injury Prevention Research,St-Michael's Hospital,University of Toronto,Toronto,ON,Canada.
Michael D
MD
Cusimano
D000328:Adult; D000368:Aged; D001804:Blood Transfusion, Autologous / Q000379:methods*; D057668:Bloodless Medical and Surgical Procedures / Q000379:methods*; D016022:Case-Control Studies; D017707:Erythrocyte Transfusion / Q000379:methods; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies
D004921:Erythropoietin