title: Parenteral Iron and Recombinant Human Erythropoietin Therapy to Stimulate Erythropoiesis in Patients Undergoing Repair of Hip Fracture.
abstract: We have previously demonstrated the value of erythropoietin therapy and oral iron supplementation coupled with autologous blood donation in patients undergoing elective orthopaedic procedures. For patients undergoing non-elective surgery such as repair of hip fracture, however, alternative approaches to blood conservation must be developed. To investigate one approach, patients undergoing surgical repair of hip fracture were administered parenteral iron (Iron Dextran USP, 100 mg daily by continuous intravenous infusion) and recombinant human erythropoietin (EPO, 150 u/kg subcutaneously daily) during hospitalization in order to stimulate erythropoiesis. Of nine evaluable patients, three showed evidence of low iron stores. The median total iron therapy administered was 500 mg (the equivalent of 2 1/2 blood units). The median total EPO dose administered was 737 u/kg. The median estimated red blood cell volume produced by the combined therapy was 398 ml (the equivalent of two blood units). Six of eight patients who had reticulocyte data available showed increases in reticulocyte counts. The median admission and discharge hematocrit levels were 35.2% and 31.8%, respectively. Six of nine patients did not require allogeneic blood units. We conclude that parenteral iron supplementation and EPO therapy can stimulate effective erythropoiesis in hip fracture patients, and provide a possible approach to blood conservation in these non-elective surgical patients.
authors.affiliation: a Division of Laboratory Medicine , Washington University Medical Center , Box 8118, 660 South Euclid Avenue, St. Louis , MO 63110.
authors.forename: L T
authors.initials: LT
authors.lastname: Goodnough
authors.affiliation: b Jewish Hospital, Washington University School of Medicine , St. Louis , MO.
authors.forename: K
authors.initials: K
authors.lastname: Merkel
keywords: Blood Transfusion; Erythropoietin; Iron