Recombinant human erythropoietin and hemoglobin concentration at operationand during the postoperative period: Reduced need for blood transfusions in patients undergoing colorectal surgery - Prospective double-blind placebo-controlled study

In a double-blind placebo controlled study we investigated the effect of re combinant human erythropoietin (r-HuEPO), on the perioperative hemoglobin c oncentration and the use of blood transfusions in patients undergoing elect ive colorectal surgery with a preoperative hemoglobin level less than or eq ual to 8.5 mmol/L. Altogether 100 were included, and 81 patients could be e valuated. A total of 38 patients received r-HuEPO in a dose of 300 IU/kg bo dy weight on day 4 before surgery and 150 IU/kg daily for the following 7 d ays; 43 patients received placebo. In addition, all patients received daily doses of 200 mg iron orally for 4 days before surgery. There were no diffe rences between the two groups with regard to sex, height, weight, serum ele ctrolytes, and liver function tests at study entry. The preentry hemoglobin concentration was similar in the two groups, with a median value of 7.9 (r ange 5.3-8.5) mmol/L in the erythropoietin group and 7.6 (5.1-8.5) mmol/L i n the placebo group. On the day of surgery the median hemoglobin concentrat ion,vas 7.8 (5.3-9.2) mmol/L in the erythropoietin group and 7.2 (4.6-8.5) mmol/L in the placebo group (p < 0.05). On postoperative days 3 and 7 the v alues were 7.2 (53-8.2) and 7.5 (5.4-9.4) mmol/L, respectively, in the eryt hropoietin group compared to 6.7 (5.2-7.8) and 6.9 (5.1-8.6) mmol/L, in the placebo group (p < 0.01). At discharge the hemoglobin concentration was 7. 8 (5.9-8.8) mmol/L in the erythropoietin group and 7.2 (5.4-8.6) mmol/L in the placebo group (p < 0.002). The blood loss during operation was similar in the two groups. In the erythropoietin group the median value was 280 mi (range 25-2000 mi), with the lower and upper quartiles 150 and 500 mi, resp ectively: In the placebo group the blood loss was median 300 mi (range 50-1 800 mi), with the lower and upper quartiles 200 and 750 mi, respectively. T he number of blood transfusions given was significantly lower in the erythr opoietin group, with a mean of 0.3 (range 0-6) units compared to 1.6 (0-9) units in the control group (p < 0.05). In conclusion, the hemoglobin concen tration at the time of surgery and during the week following surgery was si gnificantly higher in the group of patients receiving r-HuEPO perioperative ly compared to the placebo group together with a significant lower use of b lood transfusions in the r-HuEPO group. However, the clinical implications of these findings has yet to be proven.