Preoperative erythropoietin in spine surgery

Abstract

IntroductionSurgery for spinal deformities or degenerative lumbar disease may be associated with blood loss ranging from 30% to 100% of the patient's total blood volume [18, 26,68,79,85,87]. This loss of blood is related to the complexity of the procedure, duration of surgery, number of fused levels, anaesthetic technique and the patient's comorbid conditions [18, 26,68,76,79,85,87]. Extensive bleeding may lead to rapid fatal consequences and to risks associated with allogenic blood transfusion [4, 8, 36,40,81]. Measures should be taken to minimise these risks [18, 26,50,58,64,65,66,68,79].Over the last 30 years, considerable efforts have been made to develop new blood-conservation strategies that Abstract Spine surgery may be associated with profuse intraoperative bleeding that often requires blood transfusions. In recent years several techniques have been developed to avoid allogenic transfusions and their potential complications to surgical patients. In this study we review and analyse the role of preoperative recombinant human erythropoietin (rHuEPO) administration in spine surgery as a blood conservation strategy. Between 1998 and 2002, a total of 250 patients scheduled for spine surgery were included in our bloodsparing program: 114 patients (group 1), operated on before rHuEPO approval (2000), underwent preoperative autologous blood donation (ABD) alone, and 136 patients operated on after rHuEPO approval (groups 2 and 3) received rHuEPO while undergoing ABD. Adding rHuEPO to ABD resulted in higher haemoglobin and haematocrit values the day of surgery, more ABD units retrieved per patient and, consequently, reduced allogenic transfusion requirements. The effectiveness of rHuEPO as the only preoperative blood conservation technique was evaluated in ten patients with a predicted blood loss of less than 30% of their total volume, scheduled for lumbar surgery. Data from these patients were matched with those from a similar group of patients who had undergone ABD. Patients receiving rHuEPO alone had higher haemoglobin levels the day of surgery than did patients in the ABD program. Neither group required allogenic transfusions. Conclusions: preoperative rHuEPO is useful for reducing allogenic blood requirements in elective spine surgery. In patients with an expected blood loss of around 50% of blood volume, rHuEPO improves ABD, minimising preoperative anaemia and increasing the number of ABD units collected. In patients with expected blood loss below 30% of total volume, rHuEPO administration may replace ABD.

Erythropoietin augments bone formation in a rabbit posterolateral spinal fusion model

“…In conclusion, EPO is a pluripotent growth factor that seems worthwhile investigating for its osteogenic and angiogenic potencies in the field of orthopedics. In the future, EPO may fill a gap in orthopedic surgery as a graft enhancer, if bone harvest is needed but insufficient and a high blood loss is anticipated in the management of both anemic and normal patients 27–29…”

Blood transfusion risks and alternative strategies in pediatric patients

“…In a review of their blood conservation program for spine surgery, Colomina et al. (61) observed that the use of preoperative erythropoietin alone allowed for a higher preoperative hematocrit compared to patients in the PAD program. Neither group required intraoperative ABT.…”

Two different dosing regimens of human recombinant erythropoietin beta during preoperative autologous blood donation in patients having hip arthroplasty

“…More than 50% of such patients require additional allogenic blood transfusions [1,2]. The goal of preoperative administration of recombinant human erythropoietin (rHu-EPO) is to increase erythropoiesis in patients who are donating blood for autologous use and therefore decrease the need for allogenic transfusions [3,4]. Previous reports found that the pharmacological response to erythropoietin therapy is a function of dose and administration regimen and that repeated administration of rHu-EPO is more effective in stimulating the reticulocyte response than is single-dose administration of the same total amount of rHu-EPO [5].…”