INCREASED HEMATOCRIT AND DECREASED TRANSFUSION REQUIREMENTS IN CHILDREN GIVEN ERYTHROPOIETIN BEFORE UNDERGOING CRANIOFACIAL SURGERY

Object. This study was undertaken to determine the efficacy of preoper ative erythropoietin administration in infants scheduled for craniofac ial surgery and, in so doing, to minimize problems associated with blo od transfusions. Methods. Families were offered the option of having t heir children receive erythropoietin injections before undergoing cran iofacial surgery. The children whose families accepted this option rec eived daily iron and 300 U/kg erythropoietin three times per week for 3 weeks preoperatively. Weekly complete blood counts with reticulocyte counts were measured and transfusion requirements were noted. Blood t ransfusions were administered depending on the clinical condition of t he child. A case-matched control population was also evaluated to comp are initial hematocrit levels and transfusion requirements. Thirty pat ients in the erythropoietin treatment group and 30 control patients we re evaluated. The dose of erythropoietin administered was shown to inc rease hematocrit levels from 35.4 +/- 0.9% to 43.3 +/- 0.9% during the course of therapy. The resulting hematocrit levels in patients treate d with erythropoietin at the time of surgery were higher compared with baseline hematocrit levels obtained in control patients at the time o f surgery (34.2 +/- 0.5%). Transfusion requirements also differed: all control patients received transfusions, whereas 64% (19 of 30) of ery thropoietin-treated patients received transfusions. Conclusions. The a uthors conclude that treatment with erythropoietin in otherwise health y young children will increase hematocrit levels and modify transfusio n requirements. Erythropoietin therapy for elective surgery in childre n of this age must be individualized according to the clinical situati on, family and physician beliefs, and cost effectiveness, as evaluated at the individual center.