Erythropoietin To Prevent Blood Transfusion in Patients Having Total Hip Replacement Surgery. Ann Intern Med. 2000;133:S55. doi: 10.7326/0003-4819-133-11-200012050-00003
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Published: Ann Intern Med. 2000;133(11):S55.
Patients can lose enough blood during hip replacement surgery to require blood transfusions. Transfusions of blood from other people always carry a small risk for infection or transfusion reactions. Transfusion of blood donated by the patient before surgery (predonation) avoids many of these problems; however, it is inconvenient, and many patients have medical conditions that prevent them from predonating blood. Erythropoietin is a protein made by the kidney that stimulates the bone marrow to make red blood cells. It is also manufactured as a drug called epoetin alfa. Giving a person epoetin alfa to build up their blood before hip replacement surgery decreases the need for transfusion. However, the best dose and timing of epoetin alfa treatment before surgery are not known.
To see whether a modified dose of epoetin alfa reduces blood transfusions in patients having hip replacement surgery.
201 patients having hip replacement surgery who did not predonate blood.
The researchers randomly assigned each patient to receive four weekly injections of a high dose (40,000 units) of epoetin alfa, a low dose (20,000 units) of epoetin alfa, or placebo, starting 4 weeks before surgery. The placebo looked like the epoetin alfa, but it contained no active ingredients. All patients also received an iron supplement, since the body needs iron to make red blood cells. The researchers then followed the patients to see who needed a blood transfusion. They also monitored patients' blood counts and looked for complications of epoetin alfa therapy, including thromboembolism (blood clots in the legs, brain, or lungs).
Five of 44 (11.4%) patients in the high-dose group and 18 of 79 (22.8%) patients in the low-dose group required transfusions, compared with 35 of 78 (44.9%) patients in the placebo group. Statistical analysis showed that both epoetin alfa groups required significantly fewer transfusions than the placebo group; patients in the high-dose group required the fewest transfusions. Blood counts improved more before surgery in the patients who received epoetin alfa than in patients who received placebo. No differences were noted among the groups in the frequency of thromboembolism.
Epoetin alfa is expensive, and the study does not address whether the observed benefit of using it before hip surgery is worth the cost. In addition, the study had limited ability to evaluate the potential side effects of epoetin alfa treatment.
Both lower and higher doses of epoetin alfa reduce the need for blood transfusion in patients having hip replacement surgery. Further studies should address the safety and costs of epoetin alfa treatment in this setting.
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The summary below is from the full report titled “Erythropoietin with Iron Supplementation To Prevent Allogeneic Blood Transfusion in Total Hip Joint Arthroplasty. A Randomized, Controlled Trial.” It is in the 5 December 2000 issue of Annals of Internal Medicine (volume 133, pages 845-854). The authors are BG Feagan, CJ Wong, A Kirkley, DWC Johnston, FC Smith, P Whitsitt, SL Wheeler, and CY Lau.
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