Does a Single Low Dose Preoperative Intravenous Erythropoietin Affect Postoperative Blood Loss and Transfusion in Elderly Hip Fracture Patients Receiving Intravenous Iron Therapy: A Randomized Controlled Trial

Main Article Content

Chavarat Jarungvittayakon Paphon Sa-ngasoongsong Kitchai Luksameearunothai Norachart Sirisreetreerux Noratep Kulachote Thumanoon Ruangchaijatuporn Sasivimol Rattanasiri Suporn Chuncharunee Patarawan Woratanarat Pongsthorn Chanplakorn

Abstract

Background: Combined recombinant human erythropoietin (rHuEPO) and iron therapy significantly reduced postoperative blood loss (PBL) and allogeneic blood transfusion (ABT) in elderly hip fracture (HF) patients. However, the minimum effective rHuEPO dosage and route had not been studied before.


Objective: To evaluate the efficacy of single low dose preoperative intravenous rHuEPO on PBL and ABT in elderly HF.


Methods: A randomized controlled trial (RCT) in 32 elderly HF underwent surgical intervention was conducted. The patients were randomly assigned to receive a single dose of 10 000 IU rHuEPO (EPO group, n = 16) or placebo (control group, n = 16) on admission. All patients were given 200-mg iron sucrose intravenously for 3 days after admission. Perioperative data, outcome related to PBL, ABT, rHuEPO adverse effects, and functional outcome during 1-year period were collected and analyzed.


Results: There was no significant difference in demographic data, postoperative complication, and functional outcome between both groups (P < .05). Total hemoglobin loss (THL) and the number of patients receiving ABT in EPO group (2.1 ± 1.0 g/dL and 12 patients) did not significant differ from those in control group (2.2 ± 0.8 g/dL and 10 patients) (P = .81 and P = .44, respectively). However, EPO group demonstrated a nonsignificant greater in hemoglobin recovery (P = .07) and increase in reticulocyte count (P = .10).


Conclusion: Combined single low dose preoperative intravenous rHuEPO with iron therapy does not significantly reduce PBL and ABT in elderly HF compared to who received intravenous iron therapy alone. However, this adjunct rHuEPO may hasten the hemoglobin recovery and helpful for the patients’ outcome.

Keywords

Article Details

How to Cite
Jarungvittayakon, C., Sa-ngasoongsong, P., Luksameearunothai, K., Sirisreetreerux, N., Kulachote, N., Ruangchaijatuporn, T., Rattanasiri, S., Chuncharunee, S., Woratanarat, P., & Chanplakorn, P. (2019). Does a Single Low Dose Preoperative Intravenous Erythropoietin Affect Postoperative Blood Loss and Transfusion in Elderly Hip Fracture Patients Receiving Intravenous Iron Therapy: A Randomized Controlled Trial. Ramathibodi Medical Journal, 42(1), 10 - 18. https://doi.org/10.33165/rmj.2019.42.1.139879
Section
Original Articles

References

1. Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: a review. World J Orthop. 2014;5(4):402-411. doi:10.5312/wjo.v5.i4.402.

2. Foss NB, Kehlet H. Hidden blood loss after surgery for hip fracture. J Bone Joint Surg Br. 2006;88(8):1053-1059. doi:10.1302/0301-620X.88B8.17534.

3. Vochteloo AJ, Borger van der Burg BL, Mertens B, et al. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients. BMC Musculoskelet Disord. 2011;12:262. doi:10.1186/1471-2474-12-262.

4. Hagino T, Ochiai S, Sato E, Maekawa S, Wako M, Haro H. The relationship between anemia at admission and outcome in patients older than 60 years with hip fracture. J Orthop Traumatol. 2009;10(3):119-122. doi:10.1007/s10195-009-0060-8.

5. Carson JL, Altman DG, Duff A, et al. Risk of bacterial infection associated with allogeneic blood transfusion among patients undergoing hip fracture repair. Transfusion. 1999;39(7):694-700. doi:10.1046/j.1537-2995.1999.39070694.x.

6. Klein HG, Spahn DR, Carson JL. Red blood cell transfusion in clinical practice. Lancet. 2007;370(9585):415-426. doi:10.1016/S0140-6736(07)61197-0.

7. Biesma DH, Van de Wiel A, Beguin Y, Kraaijenhagen RJ, Marx JJ. Post-operative erythropoiesis is limited by the inflammatory effect of surgery on iron metabolism. Eur J Clin Invest. 1995;25(6):383-389. doi:10.1111/j.1365-2362.1995.tb01718.x.

8. van Iperen CE, Kraaijenhagen RJ, Biesma DH, Beguin Y, Marx JJ, van de Wiel A. Iron metabolism and erythropoiesis after surgery. Br J Surg. 1998;85(1):41-45. doi:10.1046/j.1365-2168.1998.00571.x.

9. Goodnough LT, Merkel K. Parenteral iron and recombinant human erythropoietin therapy to stimulate erythropoiesis in patients undergoing repair of hip fracture. Hematology. 1996;1(2):163-166. doi:10.1080/10245332.1996.11746300.

10. Bernabeu-Wittel M, Romero M, Ollero-Baturone M, et al. Ferric carboxymaltose with or without erythropoietin in anemic patients with hip fracture: a randomized clinical trial. Transfusion. 2016;56(9):2199-2211. doi:10.1111/trf.13624.

11. García-Erce JA, Cuenca J, Muñoz M, et al. Perioperative stimulation of erythropoiesis with intravenous iron and erythropoietin reduces transfusion requirements in patients with hip fracture. A prospective observational study. Vox Sang. 2005;88(4):235-243. doi:10.1111/j.1423-0410.2005.00627.x.12. Garcia-Erce JA, Cuenca J, Haman-Alcober S, Martínez AA, Herrera A, Muñoz M. Efficacy of preoperative recombinant human erythropoietin administration for reducing transfusion requirements in patients undergoing surgery for hip fracture repair. An observational cohort study. Vox Sang. 2009;97(3):260-267. doi:10.1111/j.1423-0410.2009.01200.x.

13. Muñoz M, García-Erce JA, Villar I, Thomas D. Blood conservation strategies in major orthopaedic surgery: efficacy, safety and European regulations. Vox Sang. 2009;96(1):1-13. doi:10.1111/j.1423-0410.2008.01108.x.

14. Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332. doi:10.1136/bmj.c332.

15. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105(1):198-208.

16. Seeber P, Shander A. Basics of Blood Management. 1st ed. Massachusetts, USA: Blackwell Publishing; 2007:400.

17. Kristensen MT, Andersen L, Bech-Jensen R, et al. High intertester reliability of the cumulated ambulation score for the evaluation of basic mobility in patients with hip fracture. Clin Rehabil. 2009;23(12):1116-1123. doi:10.1177/0269215509342330.

Most read articles by the same author(s)