Erythropoiesis Stimulation in Patients with Postoperative Anemia
https://doi.org/10.15360/1813-9779-2013-4-59
Abstract
Early treatment for anemia with epoietin (EPO) and intravenous iron after replacement of the large lower extremity joints permits an 8 g/l increment in hemoglobin concentration to be achieved by postoperative day 10 versus day 2. Objective: to evaluate the efficiency of medical stimulation of erythropoiesis in the treatment of anemia after large joint replacement. Materials and methods. The medical records of patients who had undergone hip or knee joint replacement in January 2010 to August 2011 were retrospectively analyzed. Group 1 (EPO group) included 32 patients who postoperatively received iron saccharate 600 mg and subcutaneous epoietin alfa 40,000 IU. In Group 2 (IRON group), 27 patients took iron saccha-rate 600 mg without epoietin. In Group 3 (CON group) 62 patients had no parenteral erythropoietic stimulants. Blood hemoglobin levels on postoperative days 1, 2, and 10 were a main control indicator. Blood transfusion therapy was not performed in the identified groups. Results. In the first two days, hemoglobin levels were statistically significantly higher in the CON group than those in the EPO group and on day 10 intergroup differences were absent. By day 10 versus day 2, a statistically significant increase in hemoglobin concentrations was found in the EPO and IRON groups. In the EPO group, the hemoglobin concentration increment was significantly higher than that in the CON group. There were no clinical signs of thrombosis and thromboembolic events in the patients of the study groups. Conclusion. The co-administration of intravenous iron and epoietin enables an 8 g/l increase to be achieved on postoperative day 10 versus day 2. Key words: joint replacement, anemia, epoietin, iron saccharate, intravenous iron.
References
1. Musallam K.M., Tamim H.M., Richards T., Spahn D.R., Rosendaal F.R., Habbal A., Khreiss M., Dahdaleh F.S., Khavandi K., Sfeir P.M., Soweid A., Hoballah J.J., Taher A.T., Jamali F.R.Lancet.
2. Goodnough L.T., Maniatis A., Earnshaw P., Benoni G., Beris P., Bisbe E., Fergusson D.A., Gombotz H., Habler O., Monk T.G., Ozier Y., Slappendel R., Szpalski M.Detection, evaluation, and management of preoperative anaemia in the elective orthopaedic surgical patient: NATA guidelines.Br. J. Anaesth.2011; 106 (1): 13-2
3. Spahn D. R.Anemia and patient blood management in hip and knee surgery.Anesthesiology.2010; 113 (2): 482-495.
4. Мороз В.В., Голубев А.М., Афанасьев А.В., Кузовлев А.Н., Сергунова В. А., Гудкова О.Е., Черныш А.М.Строение и функция эритроцита в норме и при критических состояниях.Общая реаниматология.2012; 8 (1): 52—60.
5. Мороз В.В., Голубев А.М., Черныш А.М., Козлова Е.К., Васильев В.Ю., Гудкова О.Е., Сергунова В.А.Изменение структуры поверхности мембран эритроцитов при длительном хранении донорской крови.Общая реаниматология.2012; 8 (1): 5—12.
6. Мороз В.В., Голубев А.М., Козлова Е.К., Афанасьев А.В., Гудкова О.Е., Новодержкина И.С., Марченков Ю.В., Кузовлев А.Н., Заржецкий Ю.В., Костин А.И., Волков Д.П., Яковлев В.Н.Динамика морфологических изменений эритроцитов и биохимических показателей консервированной цельной крови в различные сроки хранения.Общая реаниматология.2013; 9 (1): 5—13.
7. Carson J.L., Terrin M.L., Noveck H., Sanders D.W., Chaitman B.R., Rhoads G.G., Nemo G., Dragert K., Beaupre L., Hildebrand K., Macaulay W., Lewis C., Cook D.R., Dobbin G., Zakriya K.J., Apple F.S., Horney R.A., Magaziner J.; FOCUS Investigators.Liberal or restrictive transfusion in high-risk patients after hip surgery.N. Engl. J. Med.2011; 365 (26): 2453—2462.
8. Beris P., Munoz M., Garcfa-Erce J. A., Thomas D., Maniatis A., Van der Linden P.Perioperative anaemia management: consensus statement on the role of intravenous iron.Br.J. Anaesth.2008; 100 (5): 599-604.
9. Загреков В.И., Таранюк А.В., Максимов ГА., Ежов И.Ю.Предоперационная стимуляция эритропоэза у больных с анемией.Общаяреаниматология.2010; 6 (2): 56—61.
10. Garcia-Erce JA., Cuenca J., Haman-Alcober S., Martinez A.A., Herrera A., Munoz 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.
11. Weber E.W., Slappendel R., Hemon Y., Mahler S., Dalen T., Rouwet E., van Os J., Vosmaer A., van der Ark P.Effects of epoetin alfa on blood transfusions and postoperative recovery in orthopaedic surgery: the European Epoetin Alfa Surgery Trial (EEST).Eur.J. Anaesthesiol.2005; 22 (4): 249—257.
12. Shander A., Spence R.K., Auerbach M.Can intravenous iron therapy meet the unmet needs created by the new restrictions on erythropoiet-ic stimulating agents?Transfusion.2010; 50 (3): 719—732.
13. Приказ Минздрава РФ от 25.11.2002 № 363 «Об утверждении инструкции по применению компонентов крови».
14. Yoo Y., Shim J., KimJ.,Jo Y., LeeJ., Kwak Y.Effect of single recombinant human erythropoietin injection on transfusion requirements in preop-eratively anemic patients undergoing valvular heart surgery.Anesthesiology.2011; 115 (5): 929-937.
15. Герасимов Л.В., Саморуков В.Ю., Мороз В.В., Иванова Г.П.Применение эритропоэтина у больных с травмой и кровопотерей.Общаяреаниматология.2012; 8(5): 11—18.
16. CallaghanJ. J., SpitzerA. I.Blood management and patient specific transfusion options in total joint replacement surgery.Iowa Orthop. J.2000; 20: 36—45.
Review
For citations:
Borisov D.B., Markov B.B., Mezentsev P.A., Poskotinov I.R., Istomina N.A. Erythropoiesis Stimulation in Patients with Postoperative Anemia . General Reanimatology. 2013;9(4):59. (In Russ.) https://doi.org/10.15360/1813-9779-2013-4-59
Views:
2058
Email this article 