Role of preoperative erythropoietin in the optimization of preoperative anemia among surgical patients — A systematic review and meta-analysis

Abstract Preoperative anemia is a common finding. Preoperative allogeneic transfusion, iron therapy, vitamin supplementation and erythropoietin therapy are the current management strategies for preoperative anemia. Previous reviews regarding erythropoietin were limited to specialties, provided little evidence regarding the benefits and risks of erythropoietin in managing preoperative anemia and included non-anemic patients. The purpose of our systematic review was to determine the role of erythropoietin solely in preoperatively anemic patients and to investigate the complications of this treatment modality to produce a guideline for preoperative management of anemic patients for all surgical specialties. The PubMed/Medline, Google Scholar, and Cochrane Library were searched for randomized trials evaluating the efficacy of erythropoietin in preoperative anemia. The risk ratio (RR) and standardized mean difference (SMD) was used to pool the estimates of categorical and continuous outcomes, respectively. Allogeneic transfusion and complications and the 90-day mortality were the primary outcomes, while the postoperative change in hemoglobin, bleeding in milliliters and the number of red blood cell (RBC) packs transfused were the secondary outcomes. Results: Eight studies were included, comprising 734 and 716 patients in the erythropoietin group and non-erythropoietin group, respectively. The pooled estimate by RR for allogeneic transfusion was 0.829 (p = 0.049), while complications and the 90-day mortality were among the 1,318 (p = 0.18) patients. Conclusion: Preoperative erythropoietin provides better outcomes, considering the optimization of preoperative anemia for elective surgical procedures. The benefits of erythropoietin are significantly higher, compared to the control group, while the risks remain equivocal in both groups. We recommend preoperative erythropoietin in anemic patients.

Effect of unadjusted dose of erythropoietin on hemoglobin in chronic renal failure patients

To assess the response of unadjusted dose of erythropoietin with respect to weight in patients on dialysis. Fifty-five patients who previously had three dialysis sittings, had received erythropoietin for at least one month and were coming on regular follow up dialysis in dialysis clinic of Shifa International Hospital, Islamabad were included in this study. Erythropoietin was given subcutaneously twice a week adding to a dose of 4000 units per week. Hemoglobin level was determined at the end of study period. The over all increase in hemoglobin after the administration of erythropoietin was 1.18 +/- 0.06 g/dl. 87.3% patients responded to erythropoietin and showed a rise in their hemoglobin, while 12.7% did not respond. Unadjusted dose of erythropoietin showed increase in hemoglobin but in most of the cases failed to achieve the target hemoglobin. In order to achieve the target hemoglobin, administration of adjusted doses of rHuEPO is required