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Online ISSN 1827-1707
Blonna D. 1, Calvi V. 2, Collo G. 1, Rossi R. 1, Castoldi F. 1
1 Divisione Universitaria di Ortopedia e Traumatologia Ospedale Mauriziano Umberto I, Torino
2 Servizio di Anestesia e Rianimazione Ospedale Mauriziano Umberto I, Torino
Aim. The patients undergoing major orthopedic surgery often need homologous blood to compensate perioperative loss. The purpose of this study was to determine the efficacy of recombinant-human erythropoietin to reduce the use of homologous blood, in patients undergoing total hip joint replacement surgery.
Methods. Thirty patients were allocated, according to the baseline hemoglobin level that was estimated 1 month before surgery, to one of the 3 treatment groups: Group A: Hb≤12.5 g/dl, 2 doses of 40 000 IU of Epoetin-a on days -14 and -7; Group B: 12.6≤Hb≤13.8 g/dl, preoperative autologous donation (PAD) with 2 doses of 40 000 IU of Epoetin-a on days -14 and -7; Group C: Hb>13.8 g/dl, only PAD. In order to change the treatment according to response, the Hb level was revalued on day -1, and if it was ≤13 g/dl, Epoetin-a 40 000 IU was administered.
Results. The average Hb level on day -1 increased of 13% in Group A patients compared with the previous values, and then were transfused with homologous blood less than in the not-treated group. In Group B patients, the average Hb level, on day -1, decreased less than in not-treated group, though they predonated more autologous units.
Comparing the patients with baseline Hb>12.5 g/dl, the rate of breakthrough transfusion was the same between the treated and not-treated group.
Conclusion. The weekly treatment with Epoe-tin-a as well as to a larger stratification of the patients, improved the cost/effective ratio of the blood management in major orthopedic surgery, particularly in patients with the highest preoperative transfusion risk.