Preoperatiye Erythropoietin In Conjunction With Acute Normovolumic Hemodilution Is An Appropriate Allogenic I^Blood Transfusion Sparing Strategy
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This study aimed to evaluate the preopemtive preparation by erythropoietin and iron supplements in conjunction with acute normaoolumic hemodilution (ANHD) as allogenic blood transfusion sparing strategy for patients undergoing major orthopedic surgery (MOS). Patients & Methods : The study comprised 60 patients assigned to undergo elective MOS. Eligible patients liadltemoglobm concentration (Hb cone.) of 9.8-13.7g/dl, and did not donate blood. Patients toere divided into 3 equal groups; Control group assigned to receive allogenic blood transfusion if they required, ANHD group assigned to undergo preoperative ANHD and Epoetin group assigned to receive preoperative erythropoietin with co-administration of pure iron medication for 4 weeks preoperatively and then underwent ANHD procedure. Venous blood samples were obtained for estimation of serum urea, creatinine, platelet count (Plat. C), iron indices and coagulation profile determination. Iron indices and coagulation profile were determined preoperatively, after ANHD, post-transfusion and at discharge. Intra- and postoperative blood loss was determined and on the 5'* postoperative day, all patients underwent duplex ultrasonography to evaluate both legs for the presence of deep vein thrombosis (DVT). Results : Epoetin-alfa significantly induced erythropoiesis with elevation ofHb cone, associated with anonsignificant decrease in S. iron andferritin concentrations estimated at day of surgery, in comparison to control and ANHD groups. Henwdilution induced significant (p < 0.05) decrease in Hb cone, in ANHD group compared to the otlier 2 groups and significant (p < 0.05) decrease ofS. iron andferritin concentrations in ANHD and Epoetin groups compared to control group. Post-transfiision and at time of discharge, Hb cone, slwwed a significant (p < 0.05) increase in epoetin group compared to the other groups. Post-transfusion coagulation profile showed significant (p<0.05) increase in Plat. C, ATTII and plasma fibrinogen, xoith a significant (p < 0.05) reduction ifaPTT in epoetin and ANHD groups compared to control group but by time of disclutrge, difference was nonsignificant. The rate of transfusion was 15% in Epoetin, 30% in ANHD and 20% hi control groups. There was a significant (p<0.05) reduction in transfusion rate in patients received Epoeiinslfa compared with tlie other two groups, (X7= 6.25, p < 0.05). In Epoetin group, no patient needed allogenic blood transfitsion, while in ANHD group 4 patients required supplemental allogenic blood transfiision. Only one patient in control group had symptomatic proximal DVT, while the other 7 patients had distal DVT. Conclusion: In conclusion, preoperative S.C. administration ofepoetin-aljafbr 4 weeks prior to surgery (in a total dose of 600 ltd/kg) coupled with oral iron therapy in conjunction with preoperative ANHD completely prevented tile need for allogenic transfusion, significantly reduced the frequency iff postoperative DVT, and proved to be a best allogenic blood transfusion-sparing strategy.