losartan-potassium and Transfusion-Reaction

Postoperative nosocomial infection (PNI) is a severe complication in surgical patients. Known risk factors of PNI such as allogeneic blood transfusions (ABTs), anemia, and iron deficiency are manageable with perioperative intravenous (IV) iron therapy. To address potential concerns about IV iron and the risk of PNI, we studied a large series of orthopedic surgical patients for possible relations between IV iron, ABT, and PNI.. Pooled data on ABT, PNI, 30-day mortality, and length of hospital stay (LHS) from 2547 patients undergoing elective lower-limb arthroplasty (n = 1186) or hip fracture repair (n = 1361) were compared between patients who received either very-short-term perioperative IV iron (200-600 mg; n = 1538), with or without recombinant human erythropoietin (rHuEPO; 40,000 IU), or standard treatment (n = 1009).. Compared to standard therapy, perioperative IV iron reduced rates of ABT (32.4% vs. 48.8%; p = 0.001), PNI (10.7% vs. 26.9%; p = 0.001), and 30-day mortality (4.8% vs. 9.4%; p = 0.003) and the LHS (11.9 days vs. 13.4 days; p = 0.001) in hip fracture patients. These benefits were observed in both transfused and nontransfused patients. Also in elective arthroplasty, IV iron reduced ABT rates (8.9% vs. 30.1%; p = 0.001) and LHS (8.4 days vs.10.7 days; p = 0.001), without differences in PNI rates (2.8% vs. 3.7%; p = 0.417), and there was no 30-day mortality.. Despite known limitations of pooled observational analyses, these results suggest that very-short-term perioperative administration of IV iron, with or without rHuEPO, in major lower limb orthopedic procedures is associated with reduced ABT rates and LHS, without increasing postoperative morbidity or mortality.

Topics: Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Blood Transfusion; Cross Infection; Erythropoietin; Female; Hematinics; Humans; Injections, Intravenous; Iron; Length of Stay; Male; Middle Aged; Morbidity; Observational Studies as Topic; Orthopedic Procedures; Perioperative Period; Retrospective Studies; Risk Factors; Time Factors; Transfusion Reaction

This article describes the incidence and etiology of anemia in critically ill children. In addition, the article details the pathophysiology and clinical ramifications of anemia in this population. The use of transfused packed red blood cells as a therapy for anemia in critically ill patients is also discussed, including the indications for and complications associated with this practice as well as potential reasons for these complications. Finally, the article lists some therapeutic practices that may lessen the risks associated with transfusion, and briefly discusses the use of blood substitutes.

Topics: Acute Lung Injury; Anemia; Blood Substitutes; Blood Transfusion; Child; Child, Preschool; Critical Illness; Erythropoietin; Hemodilution; Humans; Immunomodulation; Infant; Infant, Newborn; Infant, Premature; Iron; Phlebotomy; Risk Factors; Transfusion Reaction; Treatment Outcome

Topics: Anemia; Erythrocyte Transfusion; Erythropoietin; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Recombinant Proteins; Transfusion Reaction

Thromboembolic complications are the second leading cause of death in cancer patients. In contrast to the large body of literature on venous thromboembolism (VTE), relatively few reports have focused on the pathogenesis, incidence, management and outcomes of arterial thromboembolic events in patients with malignancy. The purpose of this article is to review the current literature on the etiology, mechanisms, and prognosis of arterial thromboembolic events in cancer patients and outline appropriate screening and management guidelines that may help lower the rates of morbidity and mortality related to these events.

Topics: Algorithms; Amyloidosis; Antineoplastic Agents; Antiphospholipid Syndrome; Erythropoietin; Female; Humans; Ischemia; Male; Myeloproliferative Disorders; Neoplasms; Neurofibromatosis 1; Peripheral Arterial Disease; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prognosis; Radiation Injuries; Recombinant Proteins; Risk Factors; Thromboembolism; Thrombophilia; Transfusion Reaction

Blood transfusion is a not causal therapeutic option in symptomatic anemia. For long time, since the discovery of the blood circulation and the first experiments in transfusion over 300 years ago, blood transfusions were the only possibility to improve the tissue oxygenation. Pretransfusion testing of the blood components as well as of the donor and the recipient has made transfusion of allogeneic blood increasingly safe. Despite transfusion reactions still do occur, they have considerably diminished, inter alia by the introduction of hemovigilance systems and decreasing the hemoglobin value used as transfusion trigger, hence performing less unnecessary transfusions. In chronic anemia, usually accepted transfusion triggers today are 70 g/l hemoglobin in patients without comorbidities. The use of erythropoetin stimulating agents is widely used and should - after a careful examination of the anemia - be considered early in the treatment plan in patients with chronic anemic.

Topics: Anemia; Blood Transfusion; Chronic Disease; Erythropoietin; Humans; Transfusion Reaction

Bone marrow suppression after intensive chemotherapies in patients with myeloid leukemia is severe, resulting in the reduction of the number of white blood cells, red blood cells, and platelets. Supportive therapies are indispensable for the management of these leukemia patients. The improvement of blood cell transfusion can decrease side effects of chemotherapies and establish the safety. But we still have notable side effects of transfusion such as TRALI (transfusion-related acute lung injury), platelet immunologic refractory state, and so on. Cytokine therapy especially with G-CSF (granulocyte colony-stimulating factor) administration, changed the treatment of myeloid leukemia. G-CSF can shorten the duration of neutropenia and decrease the risk of infection. Recently the effects of Epo (erythropoietin) on chemotherapy-induced anemia have been demonstrated. We discuss here the indications of blood cell transfusion and cytokine therapies in the treatment for myeloid leukemia.

Topics: Acute Lung Injury; Antineoplastic Agents; Blood Component Transfusion; Blood Transfusion; Erythropoietin; Graft vs Host Disease; Granulocyte Colony-Stimulating Factor; Humans; Leukemia, Myeloid; Practice Guidelines as Topic; Transfusion Reaction

In addition to more restrictive "transfusion triggers", presently available allogeneic blood conservation strategies in surgery include preoperative increase in red blood cells (RBC) mass, techniques or pharmaceutical agents that reduce blood loss, and perioperative blood salvage. Because of very important risk reduction in allogeneic blood, benefit/risk of preautologous blood donation (PAD) is quite questionable at this moment. Indeed, at this moment in France, we focus to avoid any transfusion (allogeneic and autologous blood). Therefore the most important techniques used are pharmacological: erythropoietin before surgery with a number of injections related to baseline Hb, and tranexamic acid during and after surgery. Cell saving is used only if bleeding is enough important like arthroplasty revisions. All blood conservation techniques carry their own efficiency limits, constraints and risks that, in addition to institutional considerations and individual patient characteristics are determinant to settle a blood conservation strategy. The choice of a technique should take into account (a) the delay before surgery, (b) the anticipated blood loss for the procedure that varies among institutions, (c) the tolerable blood loss without transfusion for the patient, and (d) the efficacy of the blood conservation technique in the given setting. Nevertheless, at this moment in France, it is quite important to notice that the risk of delay or lack of transfusion induces much more deaths that the transfusion itself during or after anesthesia [Anesthesiology 105, 1087-97].

Topics: Anemia; Aprotinin; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Drug Administration Schedule; Erythropoietin; Ferric Compounds; Ferric Oxide, Saccharated; Ferritins; Glucaric Acid; Hematinics; Hemodilution; Humans; Intraoperative Complications; Orthopedic Procedures; Postoperative Hemorrhage; Preoperative Care; Recombinant Proteins; Sucrose; Time Factors; Tranexamic Acid; Transfusion Reaction

Transfusion therapy in the intensive care unit is an ever-growing field, with new understanding of potential complications, new drug therapies to reduce the need for transfusion, and new additions in component therapy. In addition to the risks of sepsis, ABO blood group mismatch, and other complications associated with transfusion, the intensivist needs to be familiar with alternative therapies to minimize transfusion.. Transfusion-related acute lung injury and immunosuppression are two newly recognized complications in transfusion. Transfusion-related acute lung injury can lead to respiratory failure in an acute respiratory distress syndrome-like picture, often necessitating intubation and critical care services. Immunosuppression following transfusion has been linked to cytokine and complement activation. Recombinant erythropoietin (rHuEPO, Epogen, Procrit), by maximizing red cell counts, and aprotinin (Trasylol), by inhibiting fibrinolysis, are two old drugs being used with increasing frequency in a new setting: the intensive care unit. A new component therapy, recombinant factor VIIa (rFVIIa, NovoSeven), assists in turning on the extrinsic pathway of the coagulation cascade.. Recognizing early signs of transfusion-related acute lung injury may aid in the treatment and reporting of this entity. Realizing the mechanism and severity of immunosuppression associated with transfusion may alter transfusion triggers in the intensive care unit. rHuEPO and aprotinin are now being used with increasing frequency to increase red cell counts and minimize the need for transfusion. Recombinant factor FVIIa targets coagulation cascade activation which helps to reduce the number of units of blood products transfused in the actively bleeding patient.

Topics: Animals; Aprotinin; Blood Transfusion; Erythropoietin; Factor VIIa; Hemostatics; Humans; Immunosuppression Therapy; Intensive Care Units; Recombinant Proteins; Transfusion Reaction

Allogeneic red blood cell (RBC) transfusions are associated with multiple disadvantages, such as limited availability, high costs, multiple risks and side effects. In addition, large outcome studies comparing liberal (hemoglobin transfusion trigger range 9-10 g/dL) and restrictive (hemoglobin transfusion trigger range 7-9 g/dL) transfusion regimens still need to be performed for surgical patients. Different transfusion alternatives are known for the pre-, intra- and postoperative period. Autologous blood donation and erythropoietin are efficacious in the preoperative period. Intraoperatively, acute normovolemic hemodilution (ANH), cell salvage, antifibrinolytics, specific anesthetic and surgical techniques, coagulation monitoring, acceptance of minimal hemoglobin values and hopefully soon artificial oxygen carriers can reduce allogeneic RBC transfusions. In the postoperative period cell salvage, antifibrinolytics, and accepting minimal hemoglobin values represent alternatives to RBC transfusions. When treating a bleeding patient, the initial administration of crystalloids and colloids to restore and maintain normovolemia is important. RBC transfusions are recommended under the following circumstances: for hemoglobin levels <6 g/dL and for physiologic signs of inadequate oxygenation such as hemodynamic instability, oxygen extraction rate >50% and myocardial ischemia, detectable by new ST-segment depressions >0.1 mV, new ST-segment elevations >0.2 mV or new wall motion abnormalities by transesophageal echocardiography. The aim of this article is to review the efficacy, risk and side effects of RBC transfusions, to discuss transfusion alternatives and to summarize current indications for RBC transfusions. This information will help the physician to judiciously use RBC transfusions when they are indeed indicated.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Anemia; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Cardiovascular Diseases; Child; Critical Care; Erythropoietin; Hemoglobins; Hemorheology; Humans; Immune System; Infant, Newborn; Oxygen; Oxyhemoglobins; Postoperative Period; Risk; Sepsis; Transfusion Reaction

Colorectal cancers are classically revealed by a low digestive bleeding, which can be occult or exteriorized. They commonly present anemia at the diagnosis leading to particular outcomes. Perioperative blood transfusions are frequently indicated for the treatment of localized tumors and for hepatic resection of metastatic lesions but transfusions seem to have a negative impact on prognosis by increasing infections and potentially recurrence. In this context, various strategies aim at limiting the transfusional risk (autologous transfusion, preoperative use of erythropoietin...). Anemia associated with advanced colorectal cancers provides the same interest as for any metastatic tumor, as quality of life of patients is correlated to the hemoglobin's level.

Topics: Anemia, Iron-Deficiency; Blood Transfusion; Colorectal Neoplasms; Erythropoietin; Gastrointestinal Hemorrhage; Humans; Recombinant Proteins; Rectum; Transfusion Reaction

A long-term observational study of Hb E-beta-thalassemia in Sri Lanka is beginning to define some of the genetic and environmental factors that are responsible for its remarkable phenotypic variability. In this population there is a very small difference between the steady-state hemoglobin levels between the mild and severe phenotypes, and it has been possible to stop transfusion in many of those who have been on long-term treatment of this kind. These preliminary observations, made over the last 7 years, provide directions for future research into this increasingly important disease.

Topics: Adolescent; Adult; beta-Thalassemia; Blood Transfusion; Case Management; Child; Child, Preschool; Combined Modality Therapy; Erythropoietin; Female; Genetic Heterogeneity; Hemoglobin E; Hemoglobins; Humans; Infant; International Cooperation; Iron Overload; Longitudinal Studies; Male; Middle Aged; Phenotype; Pregnancy; Pregnancy Complications, Hematologic; Severity of Illness Index; Splenectomy; Sri Lanka; Transfusion Reaction

Anemia is a common problem in critically ill patients. As a result, blood transfusions are often used in the intensive care unit (ICU) setting. However, mounting evidence shows that blood transfusions may contribute to negative outcomes, such as transfusion-related infections, organ dysfunction, and immunosuppression. Supplementation with epoetin alfa is currently used in some medical centers to manage anemia in critically ill patients.. This review discusses the risks with blood transfusions and the clinical evidence supporting the use of epoetin alfa in managing edema during critical illness.. A search was conducted in MEDLINE and Current Contents (1966-2003) using the terms epoetin alfa, recombinant human erythropoietin, and anemia. Articles addressing anemia and the use of epoetin alfa in critically ill patients were selected and assessed. From this selection, the cited references addressing the etiology of anemia in the ICU and the risks associated with blood transfusions were manually extracted and reviewed.. Several reports have shown that critically ill patients display evidence of anemia due to a blunted erythropoietin response. One large, randomized, placebo-controlled study assessed the effect of SC epoetin alfa on blood transfusions in the ICU. In this study, 40, 000 IU administered weekly for up to 4 weeks resulted in an overall transfusion reduction (9.9% absolute risk reduction; P<0.001 ). Other, smaller studies using different dosing regimens in critically ill patients have also demonstrated that epoetin alfa can decrease the need for transfusion.. The use of epoetin alfa in critically ill patients can decrease the number of blood transfusions required during hospitalization, and potentially result in transfusion avoidance. Because of the scarce amount of evidence and the diversity of dosing regimens used used, no strict recommendations can be drawn from this review.

Topics: Anemia; Critical Illness; Epoetin Alfa; Erythropoietin; Hematinics; Humans; Recombinant Proteins; Transfusion Reaction

Anemia is a common complication in patients with multiple myeloma (MM) and occurs in more than two thirds of all patients. The most frequent underlying pathophysiological mechanism is anemia of chronic disease (ACD), relative erythropoietin (EPO) deficiency (due partly to renal impairment) and myelosuppressive effects of chemotherapy, but many other factors may account for or contribute to anemia in myeloma. In patients who achieve complete remission after chemotherapy, anemia usually normalizes. Nonresponders and relapsing myeloma patients often continue to suffer from anemia. Treatment options for anemic myeloma patients include red blood cell (RBC) transfusions and recombinant human erythropoietin (rHuEPO). Red blood cell transfusions convey an immediate effect and rapidly increase the patient's hemoglobin level. Unfortunately, effects of RBC transfusions are only transient and can be associated with several risks, including infections and mild to even life-threatening immunologic reactions. rHuEPO is biologically equivalent to the human endogenous hormone EPO, and its application leads to an increase of hemoglobin levels over an extended time without the risks of blood transfusions. Several studies reported a significant improvement of erythropoiesis, reduction in transfusion need, and improved quality of life by using rHuEPO as long-term treatment of myeloma-associated anemia. Recently, an international expert panel recommended the use of rHuEPO for anemic myeloma patients where other possible causes of anemia have been eliminated.

Topics: Anemia; Cell Hypoxia; Clinical Trials as Topic; Erythropoietin; Fatigue; Humans; Models, Biological; Multiple Myeloma; Neovascularization, Pathologic; Recombinant Proteins; Transfusion Reaction; Treatment Outcome

Topics: Blood Loss, Surgical; Blood Substitutes; Erythropoietin; Humans; Iron; Perioperative Care; Transfusion Reaction

In moderately anaemic patients, Autologous Blood Donation is much less effective than Erythropoïetin (EPO) at constituting a pre-operative RBC reserve. Indeed, the ability to give blood is limited or even impossible for anaemic individuals. EPO lowers the risks associated with autologous and allogeneic transfusions, while improving probably the quality of life of the patients. EPO therapy is efficient, in moderate anaemic patients, to reduce allogeneic transfusion when iron supplementation is associated. All blood conservation techniques carry their own efficiency limits, constraints and risks that, in addition to institutional considerations and individual patient characteristics, are determinant to settle a blood conservation strategy. But to optimise benefit/cost/effectiveness of this technique, it is important to take into account the delay before surgery, the anticipated blood loss for the procedure that varies among institutions and the tolerable blood loss without transfusion for the patient. To reduce the cost, a strategy according to baseline haematocrit and to blood loss has to be adapted at each patient. Furthermore, when the delay between the first EPO injection and the surgical procedure is sufficient, the number of injections can be easily reduced to obtain the same Ht the day prior to surgery.

Topics: Anemia; Blood Transfusion, Autologous; Erythrocyte Count; Erythropoietin; Hemoglobins; Humans; Intraoperative Care; Recombinant Proteins; Safety; Transfusion Reaction; Transplantation, Homologous

The transfusion of red blood cells is still associated with possible adverse effects and a residual risk of transmission of viral and nonviral diseases. In addition, there is an increasing shortage of blood supply worldwide. These two facts together with the success experienced in the treatment of various types of anemia with recombinant human EPO, have recently led to an increasing interest in the anemia of critically ill patients. As in the anemia of chronic diseases there are several reasons that contribute to the development of anemia in patients on intensive care units: pre-existing anemia, blood loss, reduced red cell life span, impaired iron availability and a direct inhibition of erythropoiesis by inflammatory cytokines. The implications of anemia for the progression and prognosis of critical illness are still unclear and the optimal treatment, including optimal "transfusion triggers" remains controversial. Recombinant human EPO has been proven to be effective in ameliorating the anemia of critical illness in several pilot studies and is currently being tested in larger trials.

Topics: Adult; Anemia; Blood Loss, Surgical; Child; Critical Care; Critical Illness; Cytokines; Double-Blind Method; Drug Therapy, Combination; Erythrocyte Transfusion; Erythropoiesis; Erythropoietin; Hemoglobins; Humans; Iron Compounds; Jehovah's Witnesses; Middle Aged; Multicenter Studies as Topic; Pilot Projects; Placebos; Randomized Controlled Trials as Topic; Recombinant Proteins; Reticulocyte Count; Time Factors; Transfusion Reaction

Topics: Blood Specimen Collection; Blood Substitutes; Blood Transfusion; Critical Care; Epoetin Alfa; Erythropoietin; Hematinics; Hemorrhage; Hemostatics; Humans; Jehovah's Witnesses; Monitoring, Physiologic; Nurse's Role; Nursing Assessment; Oxygen Consumption; Recombinant Proteins; Risk Factors; Transfusion Reaction; Treatment Refusal

Allogenic blood transfusion may be required for the treatment of anemia due to a hematologic disease, the consequences of chemotherapy or other circumstances, such as haemorrage and/or surgery. Transfusion becomes indispensable to prevent the side effects of anemia, such as hypoxia, palpitations, tachycardia, cardiac ischemia and fatigue. However, frequent transfusions can cause several acute problems such as hemolysis, anaphylactic shock and septic shock but also chronic problems such as iron overload (hemochromatosis), alloimmunisation and metabolic disturbances. Each of these complications can produce serious consequences and could even be sometimes fatal. Therefore we should recognise, prevent and if necessary treat all these hazards. Our article emphasises the potential chronic problems. For hemochromatosis, an iron chelator (deferoxamine) should be administered. In the presence of allo-immunisation the more compatible ABO blood group must be chosen and blood products be eliminated by filtration, when there has been blood reaction. When an allo-graft of hematopoitic tissues is considered an irradiation of blood products is necessary. Research is being carried out to develop substitute products for transfusion (haemoglobine solutions) or molecules acting on the syntheses of haemoglobine (butyrate arginine). The efficacy of erythropoitine, (EPO) is well recognised for stimulation of haemoglobine syntheses in renal failure and oncology.

Topics: Anaphylaxis; Chronic Disease; Erythropoietin; Hemolysis; Humans; Iron Overload; Shock, Septic; Transfusion Reaction

Although anemia is apparently tolerated in most patients, particularly those who are relatively healthy, the ICU population must be thought of differently. Anemia in the ICU may be due to acute blood loss, phlebotomy, or to the presence of inflammatory disease. The anemia in critically ill patients resembles anemia of chronic disease, which is believed to result from a poor endogenous erythropoietin response or erythropoietin deficiency. The risks of blood transfusions are many and ICU patients may not tolerate infusions of older, stored blood. Nonetheless, hemoglobin levels at or above 100 g/L may be important for oxygen delivery to vital organs, especially in critically ill patients with increased oxygen demands. The appropriate transfusion trigger for critically ill patients in this setting remains unknown. Blood transfusions in the ICU may not improve outcomes, and numerous studies have been published to suggest the contrary, that transfusions may actually worsen patients' outcomes in certain ICU settings. Recombinant human erythropoietin (rHuEPO, epoetin alfa) has been shown to reduce transfusion needs and increase hemoglobin levels in multiple settings and now, it appears to also do so in the ICU.

Topics: Anemia; Critical Care; Critical Illness; Erythropoietin; Humans; Risk; Transfusion Reaction

Topics: Anemia; Blood Transfusion; Blood Transfusion, Autologous; Critical Care; Erythropoietin; Hemodilution; Humans; Infections; Transfusion Reaction

Topics: Aged; Erythropoietin; Fatal Outcome; Hematopoiesis, Extramedullary; Humans; Iron Overload; Leukemia, Erythroblastic, Acute; Male; Postoperative Complications; Primary Myelofibrosis; Spleen; Splenectomy; Splenomegaly; Transfusion Reaction

There are a number of problems with allogeneic blood transfusion. Some of these problems are defined and can be quantified, such as the problem of rising cost or the risk of viral infection, but some of the problems are not well defined and it is only outcome data that point to allogeneic blood transfusion contributing to patient mortality and morbidity. Autotransfusion includes any technique in which the patient's own blood is collected, processed and stored, followed by reinfusion when circumstances dictate. In the perioperative period of cardiac surgery, a number of techniques are recognized as useful in this context. Preoperative autologous donation, with or without erythropoietin supplementation, intraoperative acute normovolaemic haemodilution, intraoperative cell salvage, postoperative cell salvage (reinfusion of shed mediastinal blood) and platelet rich plasmapheresis are all techniques which are used with more or less enthusiasm to reduce the need for an allogeneic blood transfusion. Modification of the priming technique of the cardiopulmonary bypass circuit using an autologous blood prime is included in this review even though it does not fall strictly within the definition of autotransfusion. Although autotransfusion is not the answer to every problem, there is no doubt that it should play a significant part in the strategy of blood conservation.

Topics: Blood Loss, Surgical; Blood Preservation; Blood Transfusion; Blood Transfusion, Autologous; Cardiac Surgical Procedures; Cost-Benefit Analysis; Costs and Cost Analysis; Elective Surgical Procedures; Equipment Design; Erythropoietin; Hemodilution; Humans; Infections; Intraoperative Care; Length of Stay; Mediastinum; Multicenter Studies as Topic; Patient Selection; Plasmapheresis; Platelet Transfusion; Transfusion Reaction; United Kingdom

Topics: Adult; Animals; Antifibrinolytic Agents; Blood Coagulation; Blood Component Transfusion; Blood Transfusion; Blood Transfusion, Autologous; Child; Controlled Clinical Trials as Topic; Erythrocyte Transfusion; Erythropoietin; Female; Hemodilution; Hemoglobins; Humans; Immunosuppression Therapy; Male; Middle Aged; Plasmapheresis; Platelet Transfusion; Pregnancy; Preoperative Care; Retrospective Studies; Risk Factors; Surgical Procedures, Operative; Transfusion Reaction; Trauma Severity Indices; Wounds and Injuries

Topics: Blood Donors; Erythropoietin; Humans; Recombinant Proteins; Transfusion Reaction

Topics: Blood Loss, Surgical; Blood Substitutes; Blood Transfusion; Blood Transfusion, Autologous; Blood-Borne Pathogens; Epoetin Alfa; Erythropoietin; Female Urogenital Diseases; Hemodilution; Humans; Male Urogenital Diseases; Recombinant Proteins; Transfusion Reaction; Utilization Review

Reinfusion of whole blood or packed red blood cells (RBCs) increasing the haemoglobin concentration ([Hb]) above the individual's normal values increases VO2max and enhances physical performance. During submaximal exercise heart rate and blood lactate concentration ([Hla]) are reduced, while arterial blood pressure remains unchanged despite increased haematocrit (Hct). There is no method available for detecting this type of blood 'doping'. Seven weeks of injection with recombinant human erythropoietin (rhEPO) (20-40 IU per kg body weight) increased [Hb] and Hct, maximal oxygen uptake (VO2max) and physical performance were increased. The change in VO2max per gram change in [Hb] is the same after reinfusion of blood and after rhEPO injections. During submaximal exercise arterial blood pressure is increased, which despite a reduced heart rate, puts greater stress on the circulation even in trained athletes. An electrophoretic method is available to detect the use of rhEPO but it is costly and slow and therefore it can not be used in sport. Indirect markers of increased erythopoiesis may be used. However, further research in this field is necessary.

Topics: Blood Transfusion; Blood Volume; Doping in Sports; Erythrocyte Transfusion; Erythropoietin; Hemoglobins; Humans; Oxygen Consumption; Physical Endurance; Recombinant Proteins; Risk Factors; Sports; Substance Abuse Detection; Transfusion Reaction

Increasing use of maintenance parenteral iron in the erythropoietin (EPO) era has been accompanied by growing concern about iron overload. This article attempts to put the issue of iron overload in hemodialysis patients into perspective. The condition is less common in all dialysis patients today than it was in the pre-EPO era, since fewer patients are being transfused and EPO therapy shifts iron into erythroid cells. Patients with end stage renal disease (ESRD) are less likely than patients with hemochromatosis to develop iron-induced organ dysfunction. Diagnosis of iron overload is best accomplished through liver biopsy. Clinically significant iron overload, which rarely occurs if ESRD patients are properly managed, can be treated in most EPO-treated renal failure patients by simply withholding parenteral iron therapy.

Topics: Anemia, Iron-Deficiency; Biopsy; Drug Monitoring; Erythropoietin; Ferritins; Hematinics; Hematocrit; Humans; Iron Overload; Kidney Failure, Chronic; Nursing Assessment; Practice Guidelines as Topic; Renal Dialysis; Risk Factors; Tissue Distribution; Transfusion Reaction

Topics: Blood Substitutes; Blood Transfusion; Blood Transfusion, Autologous; Elective Surgical Procedures; Erythropoietin; Hemodilution; Humans; Recombinant Proteins; Transfusion Reaction

Controversies about medical practices usually arise from lack of definitive scientific studies. In the presence of continuing controversy about the appropriate hemoglobin level for ventilated (or nonventilated) infants, we can attempt to derive as much useful information as possible. In this article, the authors focus on four subjects: the physiologic role of red cells, the clinical effects of anemia and the proposed clinical benefit of red cell transfusions in preterm infants, the risks associated with transfusions, and the use of recombinant erythropoietin as an alternative to transfusion therapy.

Topics: Anemia, Neonatal; Blood Transfusion; Erythrocytes; Erythropoietin; Hemoglobins; Humans; Infant, Newborn; Infant, Premature; Respiration, Artificial; Transfusion Reaction

Our aim was to perform a systematic review to determine the efficacy and side-effects of erythropoietin, given with or without autologous predonation, to patients undergoing orthopaedic or cardiac surgery. A number of studies have been done to determine whether erythropoietin minimizes exposure to perioperative allogeneic red cell transfusion. A systematic review of all randomized trials will provide the best estimate of the efficacy and side-effects of erythropoietin therapy. All randomized trials of erythropoietin in cardiac or orthopaedic surgery that reported the proportion of patients receiving perioperative allogeneic transfusion were included. The efficacy of erythropoietin was evaluated in subgroups of patients depending upon the route of administration, dose of erythropoietin, the type of control and the methodological quality of the study report. The odds ratio for the proportion of patients transfused with allogeneic blood in studies of erythropoietin to augment autologous donation was 0.42 (95% confidence limits 0.28-0.62; P < 0.0001) for orthopaedic surgery and 0.25 (95% CI 0.08-0.82; P = 0.02) for cardiac surgery. The odds ratio for erythropoietin alone was 0.36 (95% CI 0.24-0.56; P = 0.0001) in orthopaedic surgery and 0.25 (95% CI 0.06-1.04; P < 0.06) in cardiac surgery. The route of administration, dose of erythropoietin, type of control and methodological quality of the study report had no statistically significant effect upon the odds ratios. Although there was no convincing evidence that erythropoietin used alone increased the frequency of thrombotic complications, some studies found an excess of events in erythropoietin-treated patients, and the number of patients studied was relatively small. Erythropoietin, when given alone or to augment autologous donation, decreased exposure to perioperative allogeneic transfusion in orthopaedic and cardiac surgery. Further studies are required to definitively establish the safety of erythropoietin alone, to determine the optimal dose of perioperative erythropoietin, and to compare its efficacy and cost-effectiveness with other methods of minimizing perioperative transfusion.

Topics: Blood Transfusion; Cardiac Surgical Procedures; Erythropoietin; Humans; Orthopedic Procedures; Perioperative Care; Randomized Controlled Trials as Topic; Transfusion Reaction

Anemia represents a common side effect of cancer chemotherapy, and results in diminished overall well-being as well as side effects such as dyspnea, fatigue and decreased appetite. Treatment options for chemotherapy-induced anemia are transfusion of red blood cells and s.c. erythropoietin. Although transfusion is generally well tolerated, patients usually experience fluctuating hemoglobin levels because of hesitancy to transfuse to normal hemoglobin levels. Additionally, concerns persist related to the safety of blood products, including the transmission of blood-borne pathogens, immunomodulation by transfusion and severe allergic reactions, despite advances in transfusion medicine. Erythropoietin is an effective alternative to transfusion in many patients and allows for a more consistent hemoglobin level. The costs associated with the drug have limited its use. In addition, patient preferences for the two treatment options have not been investigated. Economic analyses, including consideration of the costs associated with medical care as well as the consequences, will be essential in evaluating the potential of transfusions and erythropoietin in treating the anemia associated with cancer chemotherapy.

Topics: Anemia; Antineoplastic Agents; Blood Transfusion; Cost-Benefit Analysis; Erythropoietin; Hemoglobin A; Humans; Quality-Adjusted Life Years; Recombinant Proteins; Transfusion Reaction

To avoid the inherent risk of complications associated with perioperative allogeneic transfusion, preoperative autologous blood donation (PAD) is frequently employed by patients undergoing major elective surgical procedures. However, many patients are unable to donate a sufficient quantity of blood prior to surgery. Recent studies have shown that epoetin alfa (Procrit; Ortho-Biotech, Raritan, NJ) effectively increases red blood cell (RBC) mass when administered preoperatively and decreases the requirement for allogeneic transfusion. These studies also demonstrated that patients with baseline hemoglobin levels ranging from 10 to 13 g/dL have the highest risk for requiring allogeneic transfusions and appear to achieve the greatest benefit from epoetin alfa treatment. We evaluated several dosing regimens and schedules for perioperative epoetin alfa administration. In our initial study, the comparative efficacy of three different epoetin alfa regimens was assessed by hemoglobin concentration, hematocrit, and absolute reticulocyte counts. In addition, we analyzed the effect of accelerated erythropoiesis on iron indices and individual RBC hemoglobin content. Our study demonstrated that epoetin alfa is safe and effective in increasing RBC mass; however, iron stores considered sufficient for basal erythropoiesis may not optimally support the accelerated RBC production associated with epoetin alfa therapy. In a subsequent randomized multicenter trial, we compared weekly epoetin alfa dosing to daily dosing in patients undergoing elective major orthopedic surgery. The results of this study indicated that administering epoetin alfa on a weekly schedule for several weeks prior to surgery may be at least as effective and more convenient than perioperative daily epoetin alfa dosing.

Topics: Blood Loss, Surgical; Blood Transfusion; Epoetin Alfa; Erythropoietin; Hematinics; Humans; Randomized Controlled Trials as Topic; Recombinant Proteins; Transfusion Reaction; Transplantation, Autologous; Transplantation, Homologous

'Bloodless' medicine and surgery is saving lives of individuals whose religious faith forbids blood transfusions. And the innovations it comprises are introducing new considerations to the nursing care of many patients undergoing complex operations.

Topics: Blood Loss, Surgical; Christianity; Contraindications; Epoetin Alfa; Erythropoietin; Hematinics; Humans; Male; Middle Aged; Recombinant Proteins; Surgical Procedures, Operative; Transfusion Reaction; United States

Patients undergoing cancer surgery frequently require blood, and the transfusion of allogeneic blood in these patients has been controversially linked to an increased risk of tumor recurrence. This patient population may therefore benefit from preoperative autologous blood donation (ABD) with or without epoetin alfa therapy, although the precise impact of autologous blood transfusion has not been fully explored. In some trials, preoperative ABD reduced allogeneic blood exposure by 50% in patients undergoing surgery for cancer resection, while, in another study, perioperative treatment with epoetin alfa significantly increased hematocrit (Hct) levels preoperatively and led to a reduction in postoperative allogeneic blood exposure. A combination of epoetin alfa and preoperative ABD seems a reasonable approach to reducing allogeneic blood exposure in patients undergoing cancer surgery.

Topics: Anemia; Blood Transfusion; Blood Transfusion, Autologous; Colorectal Neoplasms; Disease-Free Survival; Epoetin Alfa; Erythropoiesis; Erythropoietin; Gastrointestinal Neoplasms; Humans; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasms; Premedication; Prospective Studies; Recombinant Proteins; Survival Rate; Transfusion Reaction; Treatment Outcome

Topics: Adolescent; Blood Group Incompatibility; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Child; Child, Preschool; Disease Transmission, Infectious; Erythropoietin; Female; Humans; Infant; Male; Orthopedics; Patient Care Planning; Transfusion Reaction; Vasopressins

Chronic anemia associated with cancer often causes poor quality of life and is often exacerbated by intensive treatment. In recent controlled trials, recombinant human erythropoietin (rhEpo) proved to be well tolerated and effective in amelioration and reduction of transfusion requirements of cancer-associated anemia. Double-blind placebo-controlled trials of rhEpo in patients undergoing allogenic, but not autologous, bone marrow transplantation showed significant acceleration of the reconstitution of erythropoiesis. Multivariate analysis revealed that serum erythropoietin levels of 100 mU/mL or greater and an increase in hemoglobin by at least 0.5 g/dL was a probable response; conversely, a serum ferritin level of 400 ng/mL or greater after 2 weeks indicated a poor response to rhEpo therapy. Further studies are needed to define patient populations in whom cost-effective rhEpo therapy is justified.

Topics: Anemia; Antineoplastic Agents; Bone Marrow Transplantation; Combined Modality Therapy; Erythropoiesis; Erythropoietin; Female; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Interleukin-3; Male; Neoplasms; Randomized Controlled Trials as Topic; Recombinant Fusion Proteins; Recombinant Proteins; Transfusion Reaction

In the United States in 1991, 290,000 or 7.1% of the 4,110,907 live births were premature infants; 53,299 or 1.3% were infants with birth weights of less than 1500 grams. Many if not all of these very low birth weight infants will require red blood cell transfusions for one of several reasons. These include exchange transfusions for hyperbilirubinemia, but most often transfusions are simple small volume transfusion also called 'topper' transfusions. Most of these small volume transfusions are given for iatrogenic blood loss or 'bleeding into the laboratory.' Studies have demonstrated that the sicker the infant, the more blood sampling is needed and the greater the exposure to red blood cell (RBC), platelet and plasma products. Simple RBC transfusions may also be given for specific clinical indications or to maintain a predetermined hemoglobin concentration. This manuscript will review the criteria for RBC transfusion in neonates and selection of product as regards anticoagulant and specialized processing. In addition, the results of recombinant erythropoietin (r-EPO) clinical trials in neonates will be discussed.

Topics: Blood; Blood Donors; Blood Transfusion; Bloodletting; Cytomegalovirus Infections; Erythrocyte Transfusion; Erythrocyte Volume; Erythropoietin; Failure to Thrive; Graft vs Host Disease; Hematocrit; Humans; Infant, Low Birth Weight; Infant, Newborn; Jaundice, Neonatal; Oxygen; Recombinant Proteins; Transfusion Reaction

As with any medical therapy, transfusion has risks and complications that are inherent in its application. There are also many options in standard approaches and alternatives to allogeneic transfusion to be considered that allow hemotherapy to be tailored to the patient's needs, maximizing benefit while reducing risk. Transfusion of standard, allogeneic components selected at random and derived from an altruistic donation by a community volunteer donor continue to comprise the majority of transfusions. However, many steps can be taken to minimize allogeneic exposure and its consequences. Transfusing only when the benefits are clinically important and justify the risks is probably most important. Options abound for pharmacologic intervention, altering collection systems and using the donor as his or her own source of blood to further reduce allogeneic exposure.

Topics: Blood Component Removal; Blood Donors; Blood Transfusion, Autologous; Cost-Benefit Analysis; Erythropoietin; Humans; Transfusion Reaction

Successful limitation of homologous blood transfusion may necessitate multiple strategies and advance planning. Preoperative and intraoperative autologous blood collection may have to be supplemented with hemostatic pharmacologic agents. The use of cytokines is increasing. More efficient use of directed donors can have an important role in blood use. As these expensive and time-consuming techniques become available, a major challenge will be to determine which patients may benefit from or really need them.

Topics: Blood Component Removal; Blood Component Transfusion; Blood Donors; Blood Transfusion; Blood Transfusion, Autologous; Christianity; Erythropoietin; Hemostasis; Humans; Transfusion Reaction

The emergence of the acquired immunodeficiency syndrome (AIDS) has fueled concerns of both physicians and their patients about safety of blood transfusions. Although AIDS has generated the most fear, the risk today is extremely remote (1/60.000 units of blood). The risk of transmitting infectious disease by homologous transfusion is decreasing, as more donor screening and testing measures are implemented. The blood supply is safer that at any time, but small transfusion risks exist. The most common problems associated with transfusions are temporary: one in 100-300 recipients will experience fever or rash. The biggest problem is a mismatch of the well-known ABO blood groups and once in every 100-400.000 transfusions the hemolytic reaction is fatal. Viral hepatitis is another serious and important risk. At present hepatitis seems to strike between 1 and 3 percent of transfusion recipients. Most, if not all, of transfusion-associated hepatitis cases are caused by hepatitis C virus. Cytomegalovirus can cause primary infection, reactivation or reinfection by transfusion. Immunosuppressed patients are more likely to develop more severe disease. Epstein-Barr virus does not seem to cause significant post-transfusion disease. Bacterial or protozoal infections are an infrequently encountered adverse effect of transfusion. However, some clinical cases document the potential hazard of blood components as a vector for bacteria or protozoa. Homologous blood transfusion down-regulates some immune functions. Host defences against malignancy and infection may in some instances be severely compromised by transfusions of homologous blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acquired Immunodeficiency Syndrome; Adult; Blood Donors; Blood Transfusion, Autologous; Deamino Arginine Vasopressin; Epoprostenol; Erythropoietin; Female; Graft vs Host Disease; Hemodilution; Hepatitis, Viral, Human; Humans; Infant, Newborn; Infections; Male; Pregnancy; Prognosis; Protozoan Infections; Risk Factors; Transfusion Reaction

I have reviewed areas of development in the use of blood and blood products, placing emphasis on the complications of transfusion, particularly transmission of infection. Alloimmunization in relation to transfusion of red cells and platelets has been covered and suggestions for reducing this problem assessed. The potential methods of avoiding the infective complications have been discussed including the screening of blood for infective agents, the virucidal treatment of blood products during the manufacturing process and white cell depletion. The use of recombinant DNA technology to produce coagulation factors offers the possibility of further reducing infective risks. An area of clinical promise is the use of haematopoietic growth factors to treat bone marrow failure, either congenital or acquired, such as the myelosuppressive effects of cancer chemotherapy, and reduce reliance on blood products. The aim of the chapter is to encourage the rational use of a limited resource by considering the risks inherent in transfusion and alternative strategies. In doing this it is important to audit current and future practice, and it is suggested that reference is made to the suggestions of Hume (1989) for quality assessment and assurance in paediatric transfusion medicine.

Topics: Acquired Immunodeficiency Syndrome; Blood Coagulation Factors; Blood Group Antigens; Blood Platelets; Blood Specimen Collection; Blood Transfusion; Blood Transfusion, Intrauterine; Child; Child, Preschool; Colony-Stimulating Factors; Erythrocyte Transfusion; Erythropoietin; Female; Fetal Blood; Fetal Diseases; Hemoglobinopathies; Humans; Immunization; Immunization, Passive; Incidence; Infant; Neoplasm Recurrence, Local; Platelet Transfusion; Pregnancy; Pregnancy Complications, Hematologic; Prenatal Diagnosis; Thrombocytopenia; Transfusion Reaction; Virus Diseases

The development and widespread availability of recombinant products will effect blood centers through reduced product use, replacement of current products, and novel applications of new products. The greatest amount of clinical experience to date has dealt with the use of recombinant human erythropoietin (r-HuEPO) in the treatment of anemia in end-stage renal failure. Data also support its use in anemia associated with acquired immune deficiency syndrome (AIDS), cancer, and chronic inflammatory diseases. This article will focus on the effect of erythropoietin on the demand for erythrocyte use.

Topics: Acquired Immunodeficiency Syndrome; Anemia; Blood Transfusion; Erythrocyte Transfusion; Erythropoietin; Hepatitis; Humans; Recombinant Proteins; Transfusion Reaction

Topics: Acquired Immunodeficiency Syndrome; Adult; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Erythropoiesis; Erythropoietin; Evaluation Studies as Topic; Female; Humans; Male; Postoperative Care; Preoperative Care; Recombinant Fusion Proteins; Surgical Procedures, Operative; Transfusion Reaction; Treatment Refusal

Topics: Anemia; Chelation Therapy; Child; Deferoxamine; Erythrocyte Transfusion; Erythropoietin; Humans; Iron; Recombinant Proteins; Transfusion Reaction

The traditional options available for the correction of hemodialysis-related anemia are blood transfusions and androgen therapy to stimulate erythropoiesis. A new therapeutic option, recombinant human erythropoietin (r-HuEPO; EPOGEN, AMGEN Inc, Thousand Oaks, CA), is currently undergoing clinical trials. Each treatment alternative has certain attendant adverse effects. The adverse effects of transfusion include transmission of infections such as hepatitis or acquired immunodeficiency syndrome, iron overload, and sensitization to histocompatibility antigens. Androgen therapy can cause masculinization of women and children and, in some forms, is associated with a high incidence of abnormal liver function. Treatment with r-HuEPO has some potential adverse effects, including hypertension, thrombosis of arteriovenous fistulae, prolonged duration of dialysis, hyperkalemia, and iron deficiency. Gradual and careful introduction of r-HuEPO should prevent hypertension from becoming problematic.

Topics: Androgens; Anemia; Erythropoietin; Female; Humans; Kidney Failure, Chronic; Male; Recombinant Proteins; Renal Dialysis; Transfusion Reaction

Topics: Erythropoiesis; Erythropoietin; Humans; Immunocompetence; Leukocytes; Renal Dialysis; Transfusion Reaction; Uremia

Topics: Acute Kidney Injury; Anemia; Anemia, Hemolytic; Blood Viscosity; Bone Marrow; Diphosphoglyceric Acids; Erythrocytes; Erythropoietin; Half-Life; Hematocrit; Hemoglobins; Hemolysis; Humans; Kidney Failure, Chronic; Oxygen Consumption; Pyelonephritis; Renal Dialysis; Transfusion Reaction

To compare transfusion requirements and erythropoietic response in preterms between schedules of rEPO administration once or three times per week, using the same weekly dose.. Prospective, randomized trial including infants weighing <1500 g at birth and/or were 32 weeks' gestation: Group 1 (60 infants) received subcutaneous rEPO at 250 units kg(-1) per dose, three times weekly for 6 weeks; Group 2 (59 infants), at 750 units kg(-1) per dose, once weekly for 6 weeks. Efficacy was evaluated based on the transfusion requirement, hemoglobin changes, reticulocyte counts, serum transferrin receptor (sTfR) and serum ferritin. The frequency of adverse effects was registered in both groups.. A total of 13 infants were transfused in each group (relative risk: 0.98; 95% confidence interval: 0.4 to 2.3). Phlebotomy loss and red blood cell transfusion volumes received were similar in both groups. Hemoglobin levels were lower at end of study in Group 2 (10.6±1.5 g dl(-1) versus 11.5±1.4 g dl(-1); P<0.003). At end of study, reticulocyte counts and sTfR values increased and serum ferritin values decreased, without significant differences between the two groups. Incidence of complications was similar in both groups.. The once-weekly rEPO schedule for very low birth weight infants proved as effective as the three-times-weekly schedule, in relation to erythropoietic stimulus and transfusion requirement.

Topics: Anemia, Neonatal; Blood Transfusion; Drug Administration Schedule; Drug Monitoring; Erythropoiesis; Erythropoietin; Ferritins; Hemoglobins; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Injections, Subcutaneous; Receptors, Transferrin; Recombinant Proteins; Reticulocyte Count; Thrombocytosis; Transfusion Reaction; Treatment Outcome

In this study, it is hypothesized that a planned increase in the dose of recombinant human erythropoietin (rh-EPO) can prevent transfusion in very low birth weight infants. Two different regimens of rh-EPO were administrated, one consisting in increasing dosage up to 5000 U/kg/wk, according to the individual reticulocytes response, and the second in a standard therapy of 1250 U/kg/wk. Fifty-one infants participated. Despite a significant higher reticulocytosis, the study was prematurely terminated due to the results of an interim analysis showing that transfusion was not avoided by increasing the rh-EPO. No significant differences were found between the two regimens concerning transfusion rate, volume transfused, gain in weight, and adverse effects. Progressive titration of rh-EPO to improve the biological response does not leave premature infants free of transfusion.

Topics: Birth Weight; Dose-Response Relationship, Drug; Double-Blind Method; Erythropoietin; Female; Hematologic Tests; Humans; Infant; Male; Recombinant Proteins; Reticulocyte Count; Reticulocytes; Reticulocytosis; Retrospective Studies; Survival Analysis; Transfusion Reaction; Treatment Outcome

One hundred patients scheduled for elective colo-rectal cancer surgery, and with a preoperative haemoglobin level < or = 8.5 mmol/l were included. Eighty-one patients could be evaluated. Thirty-eight patients received r-HuEPO in a dose of 300 IU/kg body weight on day four before surgery and 150 IU/kg, daily, for the following seven days, and 43 patients received placebo. In addition, all patients received daily doses of 200 mg iron, orally, for four days before surgery. On the day of surgery and until discharge the haemoglobin concentration was significantly higher in the erythropoietin group compared to the placebo group. The number of blood transfusions given was significantly lower in the erythropoietin group with a mean of 0.3 units per patient (0-6) compared to 1.6 units (0-9) in the control group (p < 0.05). The clinical implications of these findings has yet to be assessed.

Topics: Adult; Aged; Blood Loss, Surgical; Blood Transfusion; Colonic Neoplasms; Double-Blind Method; Erythropoietin; Female; Hemoglobins; Humans; Intraoperative Care; Male; Middle Aged; Prospective Studies; Recombinant Proteins; Rectal Neoplasms; Transfusion Reaction

The optimum regimen of epoetin alfa for prevention of allogeneic blood transfusion is unknown.. To determine whether a modified regimen of epoetin alfa reduces allogeneic blood transfusion in patients undergoing hip arthroplasty.. Randomized, double-blind, multicenter trial comparing two modified dose regimens of epoetin alfa with placebo.. 13 teaching hospitals and 4 community hospitals in Canada.. 201 patients undergoing primary hip arthroplasty who had a hemoglobin concentration of 98 to 137 g/L and did not predonate blood.. Patients were assigned in a 3:5:5 ratio to receive four weekly doses of epoetin alfa, 40 000 U (high-dose; n = 44) or 20 000 U (low-dose; n = 79), or placebo (n = 78), starting 4 weeks before surgery. All patients received oral iron supplementation, 450 mg/d, for 42 or more days before surgery.. The primary end point was allogeneic transfusion. Secondary end points were thromboembolic events and change in reticulocyte count and hemoglobin concentration.. Both modified epoetin alfa regimens significantly reduced the need for allogeneic transfusion: Five (11.4%) patients in the high-dose group (P = 0.001) and 18 (22. 8%) patients in the low-dose group (P = 0.003) had transfusion, compared with 35 (44.9%) patients in the placebo group. The hematologic response was substantial in patients who received epoetin alfa. In the high-dose group, low-dose group, and placebo group, the preoperative increase in reticulocyte count was 58.8, 37. 0 and 1.8 x 10(9) cells/L (P < 0.001), respectively, and the increase in hemoglobin concentration was 19.5, 17.2, and 1.2 g/L (P < 0.001). The incidence of thromboembolic events did not differ among groups.. Both modified epoetin alfa regimens were effective compared with placebo in reducing allogeneic transfusion in patients undergoing hip arthroplasty. Patients who received high-dose epoetin alfa had the lowest transfusion rate.

Topics: Aged; Blood Transfusion; Dietary Supplements; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Epoetin Alfa; Erythropoietin; Female; Follow-Up Studies; Hematinics; Hemoglobinometry; Humans; Iron; Male; Middle Aged; Patient Compliance; Polysaccharides; Pulmonary Embolism; Recombinant Proteins; Reticulocyte Count; Transfusion Reaction; Treatment Outcome; Venous Thrombosis

To avoid the inherent risk of complications associated with perioperative allogeneic transfusion, preoperative autologous blood donation (PAD) is frequently employed by patients undergoing major elective surgical procedures. However, many patients are unable to donate a sufficient quantity of blood prior to surgery. Recent studies have shown that epoetin alfa (Procrit; Ortho-Biotech, Raritan, NJ) effectively increases red blood cell (RBC) mass when administered preoperatively and decreases the requirement for allogeneic transfusion. These studies also demonstrated that patients with baseline hemoglobin levels ranging from 10 to 13 g/dL have the highest risk for requiring allogeneic transfusions and appear to achieve the greatest benefit from epoetin alfa treatment. We evaluated several dosing regimens and schedules for perioperative epoetin alfa administration. In our initial study, the comparative efficacy of three different epoetin alfa regimens was assessed by hemoglobin concentration, hematocrit, and absolute reticulocyte counts. In addition, we analyzed the effect of accelerated erythropoiesis on iron indices and individual RBC hemoglobin content. Our study demonstrated that epoetin alfa is safe and effective in increasing RBC mass; however, iron stores considered sufficient for basal erythropoiesis may not optimally support the accelerated RBC production associated with epoetin alfa therapy. In a subsequent randomized multicenter trial, we compared weekly epoetin alfa dosing to daily dosing in patients undergoing elective major orthopedic surgery. The results of this study indicated that administering epoetin alfa on a weekly schedule for several weeks prior to surgery may be at least as effective and more convenient than perioperative daily epoetin alfa dosing.

Topics: Blood Loss, Surgical; Blood Transfusion; Epoetin Alfa; Erythropoietin; Hematinics; Humans; Randomized Controlled Trials as Topic; Recombinant Proteins; Transfusion Reaction; Transplantation, Autologous; Transplantation, Homologous

Patients undergoing cancer surgery frequently require blood, and the transfusion of allogeneic blood in these patients has been controversially linked to an increased risk of tumor recurrence. This patient population may therefore benefit from preoperative autologous blood donation (ABD) with or without epoetin alfa therapy, although the precise impact of autologous blood transfusion has not been fully explored. In some trials, preoperative ABD reduced allogeneic blood exposure by 50% in patients undergoing surgery for cancer resection, while, in another study, perioperative treatment with epoetin alfa significantly increased hematocrit (Hct) levels preoperatively and led to a reduction in postoperative allogeneic blood exposure. A combination of epoetin alfa and preoperative ABD seems a reasonable approach to reducing allogeneic blood exposure in patients undergoing cancer surgery.

Topics: Anemia; Blood Transfusion; Blood Transfusion, Autologous; Colorectal Neoplasms; Disease-Free Survival; Epoetin Alfa; Erythropoiesis; Erythropoietin; Gastrointestinal Neoplasms; Humans; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasms; Premedication; Prospective Studies; Recombinant Proteins; Survival Rate; Transfusion Reaction; Treatment Outcome

Anaemia is common in cancer patients, with treatments including epoetins and blood transfusions. Although an increased risk of venous thromboembolism (VTE) has been associated with both therapeutics, studies comparing the risk of VTE between epoetins and transfusions in cancer patients are lacking.. A nested case-control study investigated this risk using the German Pharmacoepidemiological Research Database. Cohort members were incident cancer patients receiving first time treatment with epoetin or transfusion. A subcohort including only patients receiving chemotherapy was created, since the formally approved indication of epoetins is chemotherapy-induced anaemia. Cases were defined as patients developing VTE. For each case up to 10 gender- and age-matched controls were selected from the cohort. Multiple confounder adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for VTE and recent treatment with epoetins or transfusions (last 28 days before index date) compared with past anti-anaemic treatment were calculated by conditional logistic regression.. Among 69 888 patients receiving first time treatment with epoetin or transfusion, 3316 VTE cases were identified. The aOR for VTE was 1.31 (95% CI 1.03, 1.65) for epoetins, 2.33 (95% CI 2.03, 2.66) for transfusions, and 2.24 (95% CI 1.34, 3.77) for epoetins and transfusions. Sensitivity analyses with a stricter VTE definition or an expanded time window yielded similar results. In the chemotherapy only subcohort the risk difference between epoetins and transfusions could not be verified (aOR 1.48, 95% CI 1.10, 1.98 vs. aOR 1.80, 95% CI 1.49, 2.19). Our study confirmed known VTE risk factors including previous VTE (aOR 14.76, 95% CI 12.79, 17.03) or surgery (aOR 1.83, 95% CI 1.67, 2.01). Epoetin-associated risk decreased after a safety warning by the European Medicines Agency setting maximum haemoglobin target values to 12 g dl(-1) .. Transfusions could be associated with a higher VTE risk than epoetins in cancer patients. Moreover, current prescribing patterns may have decreased the VTE risk for epoetins.

Topics: Aged; Case-Control Studies; Combined Modality Therapy; Erythropoietin; Female; Humans; Male; Neoplasms; Risk Factors; Transfusion Reaction; Venous Thromboembolism

Hyperhemolysis is a serious transfusion reaction, most often described in patients with hemoglobinopathies. Hyperhemolysis is characterized by the destruction of host red blood cells (RBCs), in addition to donor RBCs, via an unknown mechanism.. We present the case of a 58-year-old woman with treated human immunodeficiency virus and a normal hemoglobin (Hb) electrophoresis who developed hyperhemolysis in the setting of a delayed hemolytic transfusion reaction (DHTR).. The patient was ABO group B and had a previously identified anti-Fy(b) alloantibody. After transfusion of Fy(b)--RBCs, she developed a DHTR and was found to have anti-E, anti-C(w), anti-s, and an additional antibody to an unrecognized high-frequency RBC alloantigen. Subsequent transfusion of ABO-compatible RBCs that were negative for Fy(b), E, C(w), and s antigens resulted in immediate intravascular hemolysis. In the absence of bleeding, her hematocrit (Hct) decreased to 10.2%. An extensive serologic evaluation failed to identify the specificity of the high-frequency antibody. Severe hemolytic reactions also occurred despite pretransfusion conditioning with eculizumab. The Hct and clinical symptoms slowly improved after the cessation of transfusions and treatment with erythropoietin and steroids. This case demonstrates several noteworthy features including hyperhemolysis in a patient without a Hb disorder, the development of an antibody to an unknown RBC antigen, and the failure of eculizumab to prevent intravascular hemolysis after transfusion.. Hyperhemolysis is not restricted to patients with hemoglobinopathies. Whether eculizumab offers any benefit in the hyperhemolysis syndrome or in the prevention of intravascular hemolysis due to RBC alloantibodies remains uncertain.

Topics: Acute Disease; Adrenal Cortex Hormones; Anemia, Hemolytic; Antibodies, Monoclonal, Humanized; Blood Group Incompatibility; Cholecystitis; Coombs Test; Drug Resistance; Duffy Blood-Group System; Dyspnea; Erythrocyte Transfusion; Erythropoietin; Female; Hematocrit; Hepatitis C, Chronic; HIV Infections; Humans; Isoantibodies; Middle Aged; Oxygen Inhalation Therapy; Premedication; Pulmonary Disease, Chronic Obstructive; Receptors, Cell Surface; Syndrome; Transfusion Reaction

Topics: Anemia; Blood Loss, Surgical; Blood Transfusion; Elective Surgical Procedures; Erythropoietin; Female; Hematinics; Humans; Iron; Male; Observational Studies as Topic; Perioperative Care; Postoperative Hemorrhage; Practice Guidelines as Topic; Recombinant Proteins; Risk; Transfusion Reaction; Treatment Outcome

In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. The Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use. The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.

Topics: Anemia; Antifibrinolytic Agents; Aprotinin; Blood Coagulation Factors; Blood Transfusion; Clinical Trials as Topic; Critical Illness; Crystalloid Solutions; Erythropoietin; Hematinics; Hemorrhage; Humans; Hydroxyethyl Starch Derivatives; Iron; Isotonic Solutions; Meta-Analysis as Topic; Observational Studies as Topic; Plasma Substitutes; Recombinant Proteins; Tranexamic Acid; Transfusion Reaction

A 39-year-old woman with end-stage renal disease, which was maintained on haemodialysis, developed secondary haemochromatosis after receiving blood transfusions and intravenous iron supplementation without sufficient serum ferritin concentration monitoring. The patient received intravenous deferoxamine three times a week, combined with high-dose recombinant human erythropoietin therapy and haemodialysis. After three months, improvements in biochemical indicators and iron overload were noted.

Topics: Adult; Chelating Agents; Erythropoietin; Female; Ferritins; Hemochromatosis; Hemoglobins; Humans; Kidney Failure, Chronic; Recombinant Proteins; Renal Dialysis; Sequence Analysis, DNA; Tomography, X-Ray Computed; Transferrin; Transfusion Reaction; Treatment Outcome

Preoperative anemia in patients with cancer is highly prevalent, is associated with increased perioperative morbidity and is a risk factor for transfusion. There is evidence that patients who undergo transfusions have higher morbidity, increased cancer recurrence and poorer survival. The pathophysiology of anemia is multifactorial, with an inflammatory component to which chronic blood loss and nutritional deficiencies can be associated. Therefore, preoperative anemia in patients with cancer should be treated appropriately, given that there is sufficient time in the preoperative period. Of the currently available options, parenteral iron is an effective alternative, especially for those types of cancer that have an associated hemorrhagic component.

Topics: Anemia; Biomarkers; Blood Loss, Surgical; C-Reactive Protein; Erythropoietin; Ferritins; Forecasting; Hematinics; Hemoglobins; Humans; Iron; Medical Errors; Neoplasms; Preoperative Care; Recombinant Proteins; Transfusion Reaction

The liberal use of transfusions is not only a risk for patients but also represents a significant healthcare expenditure. The rational use of allogeneic blood transfusions and the use of transfusion alternatives, such as the optimization of preoperative hemoglobin levels, can offer substantial savings to health departments by reducing the cost of transfusions and the morbidity related to the transfusions.

Topics: Anemia; Blood Banks; Blood Loss, Surgical; Blood Transfusion; Cost Savings; Cost-Benefit Analysis; Erythropoietin; Hematinics; Hematologic Tests; Hospital Costs; Humans; Iron; Perioperative Care; Postoperative Complications; Recombinant Proteins; Risk; Transfusion Reaction

Preterm very-low-birth-weight (VLBW) infants weighing <1.5 kg at birth develop anemia, often requiring multiple red blood cell transfusions (RBCTx). Because laboratory blood loss is a primary cause of anemia leading to RBCTx in VLBW infants, our purpose was to simulate the extent to which RBCTx can be reduced or eliminated by reducing laboratory blood loss in combination with pharmacodynamically optimized erythropoietin (Epo) treatment.. Twenty-six VLBW ventilated infants receiving RBCTx were studied during the first month of life. RBCTx simulations were based on previously published RBCTx criteria and data-driven Epo pharmacodynamic optimization of literature-derived RBC life span and blood volume data corrected for phlebotomy loss.. Simulated pharmacodynamic optimization of Epo administration and reduction in phlebotomy by ≥ 55% predicted a complete elimination of RBCTx in 1.0-1.5 kg infants. In infants <1.0 kg with 100% reduction in simulated phlebotomy and optimized Epo administration, a 45% reduction in RBCTx was predicted. The mean blood volume drawn from all infants was 63 ml/kg: 33% required for analysis and 67% discarded.. When reduced laboratory blood loss and optimized Epo treatment are combined, marked reductions in RBCTx in ventilated VLBW infants were predicted, particularly among those with birth weights >1.0 kg.

Topics: Anemia; Birth Weight; Blood Volume; Computer Simulation; Erythrocyte Transfusion; Erythropoietin; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Phlebotomy; Time Factors; Transfusion Reaction

Transfusion of allogeneic blood is still common in orthopedic surgery. This analysis evaluates from the perspective of a German hospital the potential cost savings of Epoetin alfa (EPO) compared to predonated autologous blood transfusions or to a nobloodconservationstrategy (allogeneic blood transfusion strategy)during elective hip and knee replacement surgery.. Individual patients (N = 50,000) were simulated based on data from controlled trials, the German DRG institute (InEK) and various publications and entered into a stochastic model (Monte-Carlo) of three treatment arms: EPO, preoperative autologous donation and nobloodconservationstrategy. All three strategies lead to a different risk for an allogeneic blood transfusion. The model focused on the costs and events of the three different procedures. The costs were obtained from clinical trial databases, the German DRG system, patient records and medical publications: transfusion (allogeneic red blood cells: €320/unit and autologous red blood cells: €250/unit), pneumonia treatment (€5,000), and length of stay (€300/day). Probabilistic sensitivity analyses were performed to determine which factors had an influence on the model's clinical and cost outcomes.. At acquisition costs of €200/40,000 IU EPO is cost saving compared to autologous blood donation, and cost-effective compared to a nobloodconservationstrategy. The results were most sensitive to the cost of EPO, blood units and hospital days.. EPO might become an attractive blood conservation strategy for anemic patients at reasonable costs due to the reduction in allogeneic blood transfusions, in the modeled incidence of transfusion-associated pneumonia andthe prolongedlength of stay.

Topics: Aged; Aged, 80 and over; Algorithms; Blood Transfusion; Cost Savings; Cost-Benefit Analysis; Epoetin Alfa; Erythropoietin; Female; Health Resources; Hip Joint; Humans; Knee Joint; Male; Middle Aged; Models, Theoretical; Orthopedics; Recombinant Proteins; Transfusion Reaction

Topics: Anemia; Austria; Blood Loss, Surgical; Blood Transfusion; Cooperative Behavior; Cost Savings; Erythrocyte Volume; Erythropoietin; Ferric Compounds; Hematinics; Hemoglobinometry; Hemostasis, Surgical; Humans; Interdisciplinary Communication; National Health Programs; Oxygen Inhalation Therapy; Patient Care Team; Preoperative Care; Transfusion Reaction

Topics: Adrenal Cortex Hormones; Aged, 80 and over; Darbepoetin alfa; Erythropoietin; Hematinics; Hemolysis; Humans; Lymphoma, Mantle-Cell; Male; Syndrome; Transfusion Reaction

Jehovah's Witness patients (Witnesses) who undergo cardiac surgery provide a unique natural experiment in severe blood conservation because anemia, transfusion, erythropoietin, and antifibrinolytics have attendant risks. Our objective was to compare morbidity and long-term survival of Witnesses undergoing cardiac surgery with a similarly matched group of patients who received transfusions.. A total of 322 Witnesses and 87 453 non-Witnesses underwent cardiac surgery at our center from January 1, 1983, to January 1, 2011. All Witnesses prospectively refused blood transfusions. Among non-Witnesses, 38 467 did not receive blood transfusions and 48 986 did. We used propensity methods to match patient groups and parametric multiphase hazard methods to assess long-term survival. Our main outcome measures were postoperative morbidity complications, in-hospital mortality, and long-term survival.. Witnesses had fewer acute complications and shorter length of stay than matched patients who received transfusions: myocardial infarction, 0.31% vs 2.8% (P = . 01); additional operation for bleeding, 3.7% vs 7.1% (P = . 03); prolonged ventilation, 6% vs 16% (P < . 001); intensive care unit length of stay (15th, 50th, and 85th percentiles), 24, 25, and 72 vs 24, 48, and 162 hours (P < . 001); and hospital length of stay (15th, 50th, and 85th percentiles), 5, 7, and 11 vs 6, 8, and 16 days (P < . 001). Witnesses had better 1-year survival (95%; 95% CI, 93%-96%; vs 89%; 95% CI, 87%-90%; P = . 007) but similar 20-year survival (34%; 95% CI, 31%-38%; vs 32% 95% CI, 28%-35%; P = . 90).. Witnesses do not appear to be at increased risk for surgical complications or long-term mortality when comparisons are properly made by transfusion status. Thus, current extreme blood management strategies do not appear to place patients at heightened risk for reduced long-term survival.

Topics: Aged; Anemia; Antifibrinolytic Agents; Blood Transfusion; Cardiac Surgical Procedures; Erythropoietin; Female; Hematinics; Humans; Jehovah's Witnesses; Length of Stay; Male; Middle Aged; Outcome Assessment, Health Care; Perioperative Care; Postoperative Complications; Research Design; Survival Analysis; Time Factors; Transfusion Reaction; Treatment Refusal; United States

To evaluate the effect of a preoperative protocol that triages patients awaiting total joint arthroplasty to one of four strategies designed to mitigate the risk of allogeneic blood transfusion (ABT) based on a priori transfusion risk on perioperative exposure to allogeneic blood.. We compared the transfusion experiences of a historical control series of 160 subjects with a study group of 160 subjects treated by protocol. Protocol subjects with hemoglobin (Hb) 100-129 g.L(-1) were given erythropoietin, dosed by weight. Subjects with Hb 130-139 g.L(-1) underwent preoperative autologous blood harvest and perioperative re-infusion as deemed clinically necessary. Subjects with Hb >139 g.L(-1) received no special intervention, unless they were aged >70 yr and weighed < 70 kg, in which case they received oral iron and folate supplementation.. The relative risk of ABT in the Study group was 0.68 (95% confidence interval 0.54-0.85). The Control group received 104 units of allogeneic blood and the Study group received 35 units (P = 0.0007). These differences cannot be explained by differences in transfusion risk or autologous units transfused. There was no worsening of anemia or its consequences in the Study group.. A simple protocol based on easily obtained preoperative clinical indices effectively targets interventions that mitigate the risk of ABT.

Topics: Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Transfusion; Clinical Protocols; Erythropoietin; Female; Hemoglobins; Humans; Length of Stay; Male; Middle Aged; Reference Values; Transfusion Reaction; Transplantation, Autologous; Treatment Outcome; Triage

To identify and quantify risk factors related to red blood cell transfusion in premature babies weighing<1,500g who received erythropoietin (EPO). Secondly, to assess the relationship between retinopathy of prematurity and rh-EPO.. Prospective descriptive study of infants admitted to the Reina Sofía University Hospital between January 2006 and March 2009. Infants reviewed had a birth weight<1,500g and gestational age<32 weeks. Infants were administered rh-EPO 750IU/kg/week subcutaneously 3 days/week/ 6 weeks. We used univariate and multivariate logistic regressions with PASW Statistics 18 for Windows.. Data were obtained from 110 infants, with a mean birth weight of 1154grs and mean gestational age of 29.3 weeks. Risk factors (OR; 95% CI) for being transfused were: male sex (4.41; 1.24-15.66), GA (1.64; 1.14-2.36, 1 week), Hb level on admission (1.45; 1.04-2.04; 1g/dl), late onset sepsis (7.75; 2.21-21.11), late onset treatment with rh-EPO (6.27; 1.22-32.35). All surgically treated infants with patent ductus arteriosus ligation or necrotizing enterocolitis needed transfusion. There is no relationship between rh-EPO administration and retinopathy of prematurity (ROP), but there was a relationship with transfusion.. Premature infants with the lower gestational age, being male, a lower Hb level on admission and late onset sepsis are those with the greatest risk for blood transfusion.

Topics: Blood Transfusion; Erythropoietin; Female; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Male; Prospective Studies; Recombinant Proteins; Retinopathy of Prematurity; Risk Factors; Transfusion Reaction

The sensibility to erythropoietin oferythroblastic islands of bone marrow which were made in different terms after the creation of transfusion polycytemia is researched. It turned out that the central macrophags of involuting erythroblastic islands are more sensible to erythropoietin than residual macrophags of bone marrow. The capability of residual macrophags to form erythroblastic islands is opened to the bigger inhibitory influence during the development of transfusion polycytemia than to the central macrjphags of involuting erythroblastic islands.

Topics: Animals; Bone Marrow; Cell Differentiation; Cells, Cultured; Erythroblasts; Erythropoiesis; Erythropoietin; Polycythemia; Rats; Recombinant Proteins; Transfusion Reaction

Deferasirox is a new iron chelator approved recently for chelation therapy in iron-overloaded patients. It is considered safe and efficacious in most patients, but has not been tested formally in patients with end-stage renal disease. We report a case of a patient with end-stage renal disease secondary to sickle cell nephropathy who developed recurrent symptomatic hypocalcemia while on therapy and later reexposure with this medication for iron overload from long-term blood transfusions. This is the first case report of this complication with deferasirox therapy in a patient with end-stage renal disease.

Topics: Adult; Anemia, Sickle Cell; Benzoates; Deferasirox; Erythropoietin; Female; Humans; Hypertension; Hypocalcemia; Iron Chelating Agents; Iron Overload; Kidney Failure, Chronic; Peritoneal Dialysis; Transfusion Reaction; Triazoles

Topics: Blood Transfusion, Autologous; Cell Separation; Equipment Design; Erythrocyte Transfusion; Erythropoietin; Hemodilution; Humans; Orthopedic Procedures; Plasmapheresis; Transfusion Reaction

Topics: Arthritis, Infectious; Blood Preservation; Blood Transfusion; Erythrocyte Aging; Erythropoietin; Humans; Macrophages; Neovascularization, Physiologic; Prosthesis-Related Infections; Surgical Wound Infection; Transfusion Reaction

To calculate the absolute risk reduction of transfusion-related adverse events, the number of patients needed to treat, and cost to avoid one transfusion-related adverse event by using erythropoietin in critically ill patients. Number needed to treat with sensitivity analysis.. Teaching hospital.. Hypothetical cohort of critically ill patients who were candidates to receive erythropoietin.. Using vs. not using erythropoietin to reduce the need for packed red blood cell transfusions.. We used published estimates of known transfusion risks: transfusion-related acute lung injury, transfusion-related errors, hepatitis B and C, human immunodeficiency virus, human T-cell lymphotropic virus, and bacterial contamination, stratified by severity. Based on the estimated risk and frequency of transfusions with and without erythropoietin, we calculated the absolute risk reduction of transfusion-related adverse events, the number needed to treat, and cost to avoid one transfusion-related adverse event by using erythropoietin. The estimated incidence of transfusion-related adverse event was 318 permillion units transfused for all transfusion-related adverse events, 58 per million for serious transfusion-related adverse events, and 21 per million for likely fatal transfusion-related adverse events. The routine use of erythropoietin resulted in an absolute risk reduction of 191 per million for all transfusion-related adverse events, 35 per million for serious transfusion-related adverse events, and 12 per million for likely fatal transfusion-related adverse events. The number needed to treat was 5,246 to avoid one transfusion-related adverse event, 28,785 to avoid a serious transfusion-related adverse event, and 81,000 for a likely fatal transfusion-related adverse event. The total cost was $4,700,000 to avoid one transfusion-related adverse event, $25,600,000 to avoid one serious transfusion-related adverse event, and $71,800,000 to avoid a likely fatal transfusion-related adverse event. The magnitude of these results withstood extensive sensitivity analysis.. From the perspective of avoidance of adverse events, erythropoietin does not appear to be an efficient use of limited resources for routine use in critically ill patients.

Topics: Bacterial Infections; Blood Group Incompatibility; Blood Transfusion; Cost-Benefit Analysis; Critical Illness; Erythropoietin; Health Care Costs; Humans; Incidence; Medical Errors; Morbidity; Pharmacoepidemiology; Recombinant Proteins; Risk; Transfusion Reaction; United States; Virus Diseases

Topics: Blood Transfusion; Cost-Benefit Analysis; Critical Illness; Erythropoietin; Health Care Costs; Humans; Morbidity; Recombinant Proteins; Transfusion Reaction; United States

Current regular blood transfusion programs and chelation treatment have considerably improved survival of patients with thalassemia, which resulted in a larger proportion of adult patients. However, disease- and treatment-related complications in these patients progress over time, causing severe morbidity and shortened life expectancy. Stem cell transplantation still remains the only cure currently available for patients with thalassemia. This study updates transplant outcomes in 107 adult patients with median age of 22 years (range, 17-35 years) who received bone marrow transplantation (BMT) from human leukocyte antigen (HLA)-identical related donors between 1988 and 1996 (group A) and describes the results of BMT in 15 adult patients with median age of 21 years (range, 17-31 years) who were treated with a new treatment protocol (Protocol 26) between 1997 and 2003 (group B). The probability of survival, event-free survival, nonrejection mortality, and rejection for group A patients were 66%, 62%, 37%, and 4%, respectively, with a median follow-up of 12 years (range, 8.3-16.2 years). Group B patients treated with the new protocol had some improvement in thalassemia-free survival (67%) and lower transplant-related mortality (27%) than that of previous protocols. However, transplant-related mortality in these high-risk patients remains elevated. Current myeloablative BMT in adult patients is characterized by higher transplant-related toxicity due to an advanced phase of disease. Although this new approach to transplant adult patients with a reduced-dose intensity-conditioning regimen has improved thalassemia-free survival, transplant-related mortality in these high-risk patients remains elevated.

Topics: Adolescent; Adult; Azathioprine; Bone Marrow Transplantation; Busulfan; Chelation Therapy; Clinical Protocols; Combined Modality Therapy; Comorbidity; Deferoxamine; Disease-Free Survival; Erythrocyte Transfusion; Erythropoietin; Female; Follow-Up Studies; Graft vs Host Disease; Granulocyte Colony-Stimulating Factor; Hematopoietic Cell Growth Factors; Hemosiderosis; Humans; Hydroxyurea; Immunosuppressive Agents; Iron Chelating Agents; Life Tables; Liver Cirrhosis; Male; Phlebotomy; Postoperative Complications; Survival Analysis; Thalassemia; Transfusion Reaction; Transplantation Conditioning; Transplantation, Homologous; Treatment Outcome; Vidarabine

Clinical uses for recombinant human erythropoietin (rHuEPO) therapy continue to expand. Initial use was in anaemia associated with end-stage renal disease, but more recently there have been many reports of the benefits of erythropoietin in other clinical situations such as cancer-related anaemia. Recombinant erythropoietin reduces the need for blood transfusion and hence exposure to donor blood products as well as improving quality of life. We report four patients who were transfusion dependent, none of whom had licensed indications for the use of recombinant erythropoietin. Two patients had microangiopathic haemolytic anaemia secondary to mechanical valve haemolysis and were unsuitable for any further cardiac intervention. One patient had anaemia of chronic disease and anti-Vel red cell antibodies, making compatible blood transfusions difficult to obtain. The fourth patient had primary thrombocythaemia and developed transfusion-dependent anaemia secondary to myelosuppressive agents. All four patients had a relative deficiency in endogenous erythropoietin levels ranging between 7 and 41 IU/l. After commencing recombinant erythropoietin therapy, all had a response in haemoglobin of at least 1 g/dl with an overall improvement in their quality of life. We conclude that rHuEPO is a very convenient and useful form of treatment in transfusion-dependent anaemia and in some cases beyond the licensed indications.

Topics: Adult; Aged; Anemia; Antineoplastic Agents; Blood Group Antigens; Drug Approval; Erythropoietin; Female; Hemolysis; Humans; Kidney Failure, Chronic; Middle Aged; Neoplasms; Recombinant Proteins; Transfusion Reaction

Although the natural history of vaccination-induced hepatitis B virus (HBV) antibodies (Abs) is becoming clearer, little is known about naturally acquired immunity. Some assume that these patients never lose their Abs.. To document the natural history of HBV immunity, we prospectively followed up all naturally immune patients initiating hemodialysis (HD) therapy at St Michael's Hospital (Toronto, Canada). Patients presenting with Ab to hepatitis B surface antigen (HBsAb) who had no history of vaccination had a core Ab level measured to confirm natural immunity. When HBsAb titer decreased to less than 10 IU/L, patients were administered a single dose of 40 microg of Engerix B vaccine (Smith Kline Beecham Pharma Inc, Oakville, Ontario, Canada) intramuscularly as a booster dose.. We identified 29 patients beginning HD therapy with natural immunity. Nine patients (30%) subsequently lost immunity (defined as Ab titer decreasing to < 10 IU/L) during follow-up. They were older and had a lower Ab titer at initiation of HD therapy. Four of 5 patients with a low response to the booster dose were 75 years or older. Two patients with a low peak Ab titer after the booster dose again had their Ab titer decrease to less than 10 IU/L after 6 and 10 months. Both patients were switched to intradermal vaccination. All other patients were still immune after a median of 26 months.. Individuals who are naturally immune against HBV may experience a decrease in Ab titer. Their responses to booster vaccinations varied widely. It is possible that elderly patients with natural immunity require closer surveillance. We provide recommendations for surveillance in these patients.

Topics: Aged; Erythropoietin; Female; Hepatitis B; Hepatitis B Antibodies; Hepatitis B Surface Antigens; Hepatitis B Vaccines; Hepatitis C; Humans; Immunity, Innate; Immunization, Secondary; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Population Surveillance; Renal Dialysis; Smoking; Transfusion Reaction; Vaccination

Topics: Blood Loss, Surgical; Blood Transfusion; Child; Child, Preschool; Erythropoietin; Humans; Infant; Recombinant Proteins; Transfusion Reaction

The role of blood transfusions and iron intake in the pathogenesis or retinopathy of prematurity (ROP) is controversial.. To evaluate the influence of packed red cell (PRC) transfusions and iron intake on ROP incidence.. Prospective observational study.. Forty-five preterm infants with birthweight <1250 g were studied. After ophthalmological study, they were divided into group A (n=24) that included newborns without ROP, and group B (n=21) that included newborns with ROP.. Logistic regression analysis demonstrated that gestational age (OR 0.61; 95% C.I. 0.41-0.90), transfusion volume during the first week (OR 1.16; 95% C.I. 1.03-1.3) and during the first 2 months of life (OR 2.93; 95% C.I. 1.52-5.62), and iron intake during the first week of life (OR 1.15; C.I. 1.01-1.32) and during the first 2 months of life (OR 2.93; 95% C.I. 1.52-5.62) were associated with the development of ROP.. Our study showed that gestational age, blood transfusion volume and iron load by transfusions are associated with the risk of occurrence of ROP in infants with a birthweight of less than 1250 g.

Topics: Erythropoietin; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Iron; Iron, Dietary; Logistic Models; Ophthalmoscopy; Prospective Studies; Retinopathy of Prematurity; Transfusion Reaction

A 33 year-old female patient presented with apparent skin pigmentation, sustained liver dysfunction and impaired glucose tolerance. She had received blood transfusions totalling more than 40,000 ml for myelodysplastic syndrome and an allogeneic bone marrow transplant from her HLA-matched sister at the age of 31. Ferrokinetic data showed a significant iron overload. Magnetic resonance imaging suggested excessive iron deposition in the liver. The patient was diagnosed as having secondary hemochromatosis. She was given subcutaneous injections of 6,000 units of recombinant human erythropoietin initially twice a week and then weekly, and phlebotomies were performed to maintain her hemoglobin level above 10 g/dl. Three years later, the total volume of phlebotomized blood reached 24,000 ml, and her ferrokinetic data, serum transaminase levels, glucose tolerance and skin color were significantly improved.

Topics: Adult; Bone Marrow Transplantation; Erythropoietin; Female; Hemochromatosis; Humans; Myelodysplastic Syndromes; Phlebotomy; Recombinant Proteins; Transfusion Reaction; Transplantation, Homologous; Treatment Outcome

Topics: Arthroplasty, Replacement, Hip; Dietary Supplements; Erythropoietin; Hemoglobins; Humans; Iron; Preoperative Care; Transfusion Reaction

Topics: Erythropoietin; Gastrointestinal Hemorrhage; Humans; Recombinant Proteins; Transfusion Reaction

Concern about the side effects of allogeneic blood transfusion has led to increased interest in methods of minimizing peri-operative transfusion. Technologies to minimize allogeneic transfusion include drugs such as aprotinin, desmopressin, tranexamic acid and erythropoietin, and techniques such as acute normovolemic hemodilution, cell salvage and autologous pre-donation.. To survey the current use in Israel of these seven technologies to minimize allogeneic blood transfusion.. Our survey was conducted in 1996-97 in all hospitals in Israel with more than 50 beds and at least one of the following departments: cardiac or vascular surgery, orthopedics, or urology. All departments surveyed were asked: a) whether the technologies were currently being used or not, b) the degree of use, and c) the factors influencing their use and non-use. The survey was targeted at the heads of these departments.. Pharmaceuticals to reduce allogeneic blood transfusion were used in a much higher proportion in cardiac surgery departments than in the other three departments. Pre-operative blood donation was used in few of the cardiac, urologic and vascular surgery departments compared to its moderate use in orthopedic departments. The use of acute normovolemic hemodilution was reported in a majority of the cardiac departments only. Moderate use of cell salvage was reported in all departments except urology where it was not used at all.. There is considerable practice variation in the use of technologies to minimize exposure to peri-operative allogeneic blood transfusion in Israel.

Topics: Aprotinin; Attitude of Health Personnel; Biomedical Technology; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Cardiac Surgical Procedures; Data Collection; Erythropoietin; Hemodilution; Hemostatics; Hospitals; Humans; Israel; Orthopedic Procedures; Perioperative Care; Practice Patterns, Physicians'; Salvage Therapy; Tranexamic Acid; Transfusion Reaction; Urologic Surgical Procedures; Vascular Surgical Procedures

Coronary artery bypass graft (CABG) surgery accounts for a substantial portion of all allogeneic units of blood transfused. Drugs and autologous blood donation (ABD) are alternative or adjunctive methods for reducing complications and costs induced by allogeneic blood transfusions. Recombinant human erythropoietin (epoetin) has the potential to decrease perioperative need for allogeneic blood during CABG, but its high cost calls for a careful economic evaluation before it can be recommended for widespread use.. A decision tree was used to compare a hypothetical strategy of no epoetin with one in which epoetin was utilized to control blood transfusion needs in CABG; each strategy was tested with and without ABD. The impact of these strategies on both the quality-adjusted life years (QALYs) and costs ($US) was calculated.. Using epoetin alone and with ABD, respectively, avoided the transfusion of 0.61 and 1.35 units of allogeneic blood per patient and saved 0.000086 and 0.000146 QALYs per patient. This made cost-effectiveness (CE) higher than $7 million and $5 million for each QALY saved, respectively. ABD alone cost more than $1 million per QALY saved. If the risk of bacterial infections following allogeneic transfusions was included in the model, epoetin alone cost $6288 per QALY saved, while ABD, both alone and with epoetin, saved money.. On the basis of the existing evidence, neither of the blood-saving strategies modeled was a cost-effective means of avoiding the deleterious health effects of perioperative blood transfusions in CABG. However, if allogeneic blood-related infections were to be considered, both ABD and epoetin would be acceptable interventions.

Topics: Aged; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Computer Simulation; Coronary Artery Bypass; Cost-Benefit Analysis; Decision Trees; Drug Costs; Erythropoietin; Feasibility Studies; Health Care Costs; Humans; Male; Models, Theoretical; Preoperative Care; Recombinant Proteins; Safety; Transfusion Reaction; Virus Diseases

Topics: Blood Loss, Surgical; Blood Transfusion, Autologous; Erythropoietin; Hemodilution; Humans; Transfusion Reaction

Because anemia is associated with reduced long-term survival, and because allogeneic transfusion is linked to increased recurrence of disease and reduced rates of long-term survival, alternative options for managing anemia in the orthopedic oncologic patient have been sought. Managing the anemia of cancer is particularly challenging given the many obstacles to employing conventional blood management options. One potential means of treating perioperative anemia in orthopedic oncologic patients involves the use of Epoetin alfa. The clinical utility of Epoetin alfa in this setting, however, must be determined in controlled trials.

Topics: Anemia; Blood Loss, Surgical; Blood Transfusion, Autologous; Bone Neoplasms; Combined Modality Therapy; Epoetin Alfa; Erythropoietin; Hematinics; Humans; Recombinant Proteins; Recurrence; Transfusion Reaction

In the management of patients requiring chronic transfusion, various parameters may be used to evaluate the degree of erythroid marrow suppression. The aim of our study was to assess which of these parameters provide the most useful assessment of erythropoiesis. We studied 27 chronically transfused patients, 19 with sickle cell disease (SS patients) and 8 with thalassemia. Thirty-one nonchronically transfused SS patients and 74 healthy children served as controls. We measured serum transferrin receptor levels, reticulocyte counts, hemoglobin (Hb) concentrations and erythropoietin levels. The serum transferrin receptor levels were very elevated in control SS patients and remained significantly elevated in those on transfusion therapy, but were normal in thalassemia patients, indicating a more complete suppression of erythropoiesis. The reticulocyte counts were elevated in all SS patients, even when on chronic transfusion, but were in the normal range in patients with thalassemia. Erythropoietin levels were elevated in patients with thalassemia and in all the SS patients. Hb levels negatively correlated with serum transferrin receptor and erythropoietin in all SS patients. In the transfused SS patients, a higher HbS level correlated with higher reticulocyte counts, transferrin receptor, and erythropoietin levels. In thalassemia patients, erythropoiesis was more completely suppressed, as reflected both by normal reticulocyte counts and near-normal transferrin receptor levels. Though the reticulocyte counts were not significantly different in the transfused SS patients, the serum transferrin receptor levels were less elevated than in SS patients not on transfusion. The serum transferrin receptor level appears to be the most useful marker of marrow erythropoietic activity in chronically transfused SS patients. We recommend that reticulocyte counts be integrated with periodic measurements of serum transferrin receptor levels.

Topics: Adolescent; Adult; Anemia, Sickle Cell; beta-Thalassemia; Child; Child, Preschool; Erythropoiesis; Erythropoietin; Female; Hemoglobins; Humans; Infant; Male; Receptors, Transferrin; Reticulocyte Count; Transfusion Reaction

Transfusion of cellular blood products during left ventricular assist device (LVAD) implantation has been associated with HLA allosensitization, resulting in the need for a negative prospective cross-match and prolonged transplant waiting times. In order to prevent this risk, we developed a protocol to avoid transfusion of cellular blood products.. The protocol included preoperative patient stabilization, perioperative recombinant erythropoietin and blood conservation strategies, and postoperative monitoring of mixed venous oxygen saturation (SVO2) to assure adequate peripheral oxygen delivery. Panel reactive antibody (PRA) was measured in all patients pre and post LVAD placement to assess HLA sensitization.. Seven consecutive patients underwent LVAD implantation without transfusion of blood or platelets, one of whom expired perioperatively. Mean hematocrit was 35.2% preoperatively, and 21.8% postoperatively, reaching a nadir of 20.2%. Postoperative SVO2 was >60% in all patients. In the six survivors, mean hematocrit reach 24.3%, 27.3%, and 33.0% by postoperative day seven, fourteen, and thirty, respectively. PRA in three patients was 0% preoperatively and remained 0% until transplantation after 33, 34, and 50 days of support. In two patients, preoperative PRA was 7% and 17%, dropped to 3% and 0% after thirty days, then progressively rose to 96% and 100% after 60 and 90 days, respectively. In one other patient, preoperative PRA was 0%, remained at 0% after thirty days, then rose to 96% by 60 days.. Avoiding transfusion of cellular blood products in LVAD recipients is safe and well tolerated, but does not universally protect from HLA allosensitization. Other factors may also produce sensitization, such as immunogenic components of the LVAD, soluble antigen in fresh frozen plasma, or latent sensitization which is not initially evident in critically ill and possibly anergic patients.

Topics: Adult; Erythropoietin; Heart-Assist Devices; Hematocrit; Histocompatibility Testing; HLA Antigens; Humans; Isoantibodies; Male; Middle Aged; Plasma; Postoperative Care; Preoperative Care; Prospective Studies; Recombinant Proteins; Transfusion Reaction

In 1980, the first Moroccan hemodialysis center was founded in Casablanca. The number of centers has been increasing since then, to reach 61 centers to wards the of 1996. There are 1800 hemodialysed (males 59%, females 41%) with and average age of 51 +/- 4 years. In about one third of the cases, the cause of the end stage renal failure remains unknown. However, chronic glomerulonephritis comes at the head of known causes (25%), followed by interstitial nephritis (19%). A temporary vascular access (catheter) was necessary in 81% of cases when dialysis has started in emergency in 61% of patients. Infections were the most frequent complications (21%) namely septicaemia (8%) and tuberculosis (7%). The vaccination against hepatitis B virus is done systematically in all the centers, and the number of chronic carriers of HBS Ag is about 7%. Further more, serological C virus is positive in 40% of the hemodialysed patients. Cardio-vascular complications were dominated by percarditis (13%) especially at the beginning of the dialysis. Anaemia remains very frequent and often very important requiring multiple blood transfusions (35%) in the absence of erythropoietin treatment. The death rate, which is very difficult to estimate, is of about 18%. Peritoneal dialysis was used in 50 patients but only four patient continued on peritoneal dialysis therapy. 108 patients were transplanted (23 cases in Morocco, 85 in other countries) with a waiting list of 0 to 12 years. Hemodialysed Moroccan's population is characterised by the high number of unknown causes and the gravity of the admission stage. A renal effort in prophylactic should be performed to avoid certain causes of renal failure.

Topics: Adolescent; Adult; Aged; Ambulatory Care Facilities; Anemia; Cardiovascular Diseases; Carrier State; Catheters, Indwelling; Child; Child, Preschool; Comorbidity; Erythropoietin; Female; Glomerulonephritis; Hepatitis, Viral, Human; Humans; Infant; Infections; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Morocco; Nephritis, Interstitial; Peritoneal Dialysis; Renal Dialysis; Transfusion Reaction; Vaccination

Topics: Anemia; Birth Weight; Erythropoietin; Gestational Age; Hemoglobins; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Recombinant Proteins; Risk Factors; Transfusion Reaction

Due to the discovery in the 1980s that blood transfusion can transmit HIV, there has been increased interest in technologies that reduce the amount of allogeneic blood used during and after surgery. These technologies include drugs (aprotinin, tranexamic acid, epsilon-aminocaproic acid, erythropoietin), devices (cell salvage), and techniques (acute hemodilution, predeposited autologous donation). The purpose of this study was to ascertain the degree of practice variation, if any, that exists for eight technologies in nine countries in orthopedic and cardiac surgery.. In each country, either all hospitals or a random sample of hospitals with medical/surgical beds were surveyed between 1995 and 1997. Two instruments were used. The first instrument was a postcard that asked recipients whether the technologies were currently being used in their hospital for orthopedic and/or cardiac surgery to reduce perioperative allogeneic transfusion. The second questionnaire elicited information regarding the degree of use both in qualitative and quantitative terms. Data were collected, entered, and analyzed in each country, with summary results submitted to the Canadian coordinating center on a standardized data collection form.. Pharmaceuticals were generally used in a much smaller proportion of hospitals in orthopedic than in cardiac surgery. Aprotinin and tranexamic acid were the drugs most frequently used in cardiac surgery. Nonpharmacological technologies were used to a greater degree than drugs in orthopedic surgery, although there was wide variation among technologies and countries. Acute hemodilution and cell salvage were used in a greater proportion of hospitals for cardiac surgery than orthopedic surgery.. The results of this survey indicate that there is considerable practice variation in the use of technologies to minimize exposure to perioperative allogeneic transfusion within and between countries.

Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Blood Transfusion; Blood Transfusion, Autologous; Cardiac Surgical Procedures; Erythropoietin; Europe; Hemodilution; Hemostatics; Humans; Israel; Japan; Medical Laboratory Science; North America; Orthopedic Procedures; Practice Patterns, Physicians'; Surveys and Questionnaires; Transfusion Reaction; Treatment Outcome

Topics: Activities of Daily Living; Anemia; Dose-Response Relationship, Drug; Epoetin Alfa; Erythropoietin; Hematinics; Hemoglobins; Humans; Injections, Subcutaneous; Orthopedics; Preoperative Care; Randomized Controlled Trials as Topic; Recombinant Proteins; Transfusion Reaction; Treatment Outcome

Before the routine use of recombinant human erythropoietin (rHuEpo), patients dialysed by peritoneal dialysis (PD) received fewer blood transfusions than patients on haemodialysis (HD). We compared transfusion practices in these groups now that the use of rHuEpo has become standard, while controlling for variables known to influence anaemia of end-stage renal disease (ESRD). Maintenance rHuEpo doses were also compared.. Data were examined for 157 HD and 126 PD patients during a 2-year period. Potential confounders included age, gender, albumin, iron deficiency, parathyroid hormone (PTH), underlying renal disease, comorbid illness, renal transplant, dialysis adequacy and duration. An intent-to-treat analysis was used, with sensitivity analyses to account for change in treatment and transplant.. Mean haemoglobin (Hb) was not different (10.47 g/dl for HD, 10.71 g/dl for PD; P = 0.45). Mean monthly transfusion rate was higher for HD (0.47 units per month vs 0.19; P < 0.01). More HD patients received at least one transfusion (52.9 vs 40.9%; P < 0.01). The maintenance rHuEpo dose was higher for HD (7370 U/week vs 5790 U/week; P = 0.01). The only factors associated with risk of being transfused were dialysis duration and mode of dialysis (less risk for PD, odds-ratio 0.57; 95% confidence interval 0.35-0.92).. Despite the routine use of rHuEpo, HD patients received more blood and rHuEpo than PD patients to achieve the same Hb. No patient factors were identified to account for this difference. The use of fewer transfusions and less rHuEpo in PD represents an advantage over HD in terms of both cost and safety.

Topics: Anemia; Blood Transfusion; Costs and Cost Analysis; Erythropoietin; Female; Hemoglobins; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis; Recombinant Proteins; Renal Dialysis; Retrospective Studies; Safety; Transfusion Reaction

Recombinant human erythropoietin (rHuEPO) has been advocated for the treatment of anaemia in patients submitted to cancer chemotherapy. We used decision analysis to compare the cost-effectiveness of rHuEPO supplemented with red blood cell (RBC) transfusions with conventional treatment with RBC transfusions alone. At baseline, we analysed the use of rHuEPO as secondary prophylaxis according to effectiveness estimates from a community-based oncology study. In order to reduce the probability of transfusions from 21.9% to 10.4%, and the number of RBC units per patient per month from 0.55 to 0.29, 150 units kg(-1) s.c. rHuEPO three times per week for 4 months resulted in an incremental cost of $189,652 per quality-adjusted life year (QALY). In patients treated with cisplatin-containing chemotherapy, rHuEPO added $190,142 per QALY. In a hypothetical scenario of a transfusion pattern that maintained the same haemoglobin level of rHuEPO-responsive patients, the marginal cost of rHuEPO was always greater than $100,000 per QALY. Results were stable with regard to variations in the probability of blood-borne infections, quality of life of responding patients and cancer-related mortality. The additional cost could be lowered to less than $100,000 per QALY by saving 4.5 RBC units over 4 months for any patient treated. In conclusion, according to current use, rHuEPO is not cost-effective in the treatment of chemotherapy-induced anaemia. More tailored utilization of the drug and better consideration of predictive response indicators may lead to an effective, blood-sparing alternative.

Topics: Aged; Anemia; Antineoplastic Agents; Cost-Benefit Analysis; Decision Support Techniques; Erythropoietin; Hepatitis C; Humans; Quality-Adjusted Life Years; Recombinant Proteins; Transfusion Reaction

Topics: Blood Component Transfusion; Blood Donors; Blood Transfusion, Autologous; Erythropoietin; Hemodilution; Hemostasis, Surgical; Humans; Patient Care Planning; Risk Factors; Transfusion Reaction

Long-term follow-up data are presented on changes in peripheral blood counts and Hb requirements of 11 patients with myelodysplastic syndromes (MDS) during iron chelation treatment with desferrioxamine for up to 60 months. The erythroid marrow activity was indirectly evaluated by repeated determinations of the serum transferrin receptor concentration. The efficacy of iron chelation was evaluated by repeated quantitative determination of the liver iron concentration by magnetic resonance imaging. Reduction in the Hb requirement ( > or = 50%) was seen in 7/11 (64%) patients. Five patients (46%) became blood transfusion independent. Platelet counts increased in 7/11 (64%) patients and the neutrophil counts in 7/9 (78%) evaluable patients. All patients in whom iron chelation was highly effective showed improvement of erythropoietic output accompanied by an increase in the serum transferrin receptor concentration. It is concluded that reduction in cytopenia in MDS patients may be accomplished by treatment with desferrioxamine, if the iron chelation is efficient and the patients are treated for a sufficiently long period of time. Exactly how treatment with desferrioxamine works remains a challenge for further investigation.

Topics: Adolescent; Aged; Bone Marrow Diseases; Chromosome Aberrations; Deferoxamine; Erythropoietin; Female; Follow-Up Studies; Hematopoiesis; Hemoglobins; Hemosiderosis; Humans; Iron; Karyotyping; Leukocyte Count; Male; Middle Aged; Myelodysplastic Syndromes; Platelet Count; Receptors, Transferrin; Transfusion Reaction; Treatment Outcome

To examine whether recombinant human erythropoietin (rhEPO) therapy results in decreased presensitization to foreign HLA antigens, we retrospectively analyzed data from 64 of 200 patients treated in a university hospital dialysis center between 1985 and 1995 who had undergone routine panel reactive antibody (PRA%) screening. Though a significant decrease in the annual frequency of highly sensitized patients over the years was noted, 16 patients followed for 27.1 +/- 3.7 months after initiation of rhEPO therapy until transplantation or blood transfusion showed no significant overall decrease in PRA%. Six highly presensitized patients had moderate but significant overall decrease in PRA%. However, in three of these patients the PRA% was unchanged and in the other three patients the PRA% remained over 50%. Thus rhEPO therapy reduced the incidence of highly presensitized patients, but previously presensitized patients remained presensitized. We conclude that removal of transfusional stimulation of lymphocytotoxic antibody production does not appear to benefit previously presensitized patients, possibly due to the maintenance of B-lymphocyte clonal expansion by unknown factors, or even by rhEPO itself.

Topics: Antilymphocyte Serum; Erythropoietin; Female; Histocompatibility Testing; HLA Antigens; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Mass Screening; Peritoneal Dialysis; Recombinant Proteins; Renal Dialysis; Retrospective Studies; Transfusion Reaction

Hepatitis C virus infection in chronic hemodialysis patients is associated with several unresolved problems. We report a 85 years old female patient in chronic hemodialysis and treated with erythropoietin, that during the course of an Herpes zoster, presented severe malaise, weight loss and muscle weakness. Two weeks later, a slight rise in serum transaminases was detected. The patient had negative antibodies for HIV and hepatitis C virus and negative hepatitis B surface antigen. A PCR test was positive for serum hepatitis C virus RNA. The patient's condition deteriorated and she died 7 days after admission. Erythropoietin administration, whose immunosuppressive effect has been reported previously, could have influenced the dismal outcome of this patient.

Topics: Aged; Aged, 80 and over; Erythropoietin; Female; Follow-Up Studies; Hepatitis C; Herpes Zoster; Humans; Renal Dialysis; Renal Insufficiency; Transfusion Reaction; Viremia

Patients with cancer often develop significant anemia, which traditionally has been successfully managed by transfusion. Although substantially safer than in the past, transfusions continue to carry a variety of risks. The recent licensing of erythropoietin now provides a second treatment option, which indicates a need to reassess the use of transfusion to manage anemia in these patients.. A 12-month retrospective chart review of all patients receiving outpatient transfusions at a large institution was used to identify patients with solid tumors (including lymphoma) requiring transfusions for any cause. Transfusions were considered as aberrations if they necessitated unusual laboratory monitoring or resulted in clinical evidence of a transfusion reaction. Patient charges proximately related to the transfusion were calculated.. A total of 219 patients requiring transfusions were identified, with 483 transfusion episodes and the use of 812 units of red cells to manage anemia (mean, 3.71 units/patient). A total of 100 aberrations were recorded. Twenty-two (10%) of 219 patients had a positive antibody screen that required further work-up; transfusion reactions occurred in 19 patients (8.7%).. Careful assessment by hematologists and oncologists of the risk:benefit ratio of erythropoietin and transfusion in patients with cancer is urged.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Blood Transfusion; Child; Child, Preschool; Cost-Benefit Analysis; Erythropoietin; Humans; Middle Aged; Neoplasms; Retrospective Studies; Risk Factors; Transfusion Reaction

Topics: Blood Transfusion; Blood Transfusion, Autologous; Cardiac Surgical Procedures; Cell Survival; Erythrocytes; Erythropoietin; Hematocrit; Humans; Plasma; Recombinant Proteins; Safety; Tissue Preservation; Transfusion Reaction

Different response patterns to recombinant human erythropoietin (rHuEpo) administration to anemic patients with myelodysplastic syndromes (MDS) are described. The biology of rHuEpo effect on erythropoiesis in patients with MDS has not been elucidated. However, until more biological information is obtained, it could be prudent to consider these response patterns as guidelines in the treatment of MDS. In the small but interesting series of nine patients with MDS only one responded to rHuEpo within the treatment period of eight weeks. Two additional patients continued the treatment on their own, and after 16 weeks a response was noted for the first time. A third patient was treated for only six weeks and a delayed response was recorded while off treatment for ten weeks. This response was also recorded 16 weeks from treatment initiation-as in the other two patients. A fourth patient with MDS developed transfusion related hemosiderosis and during iron chelation therapy the RBC transfusion rate dropped to a rate lower than the rate needed before the rHuEpo treatment. It is emphasized that in non responders, non-routine approaches should be considered.

Topics: Aged; Aged, 80 and over; Anemia, Refractory; Anemia, Sideroblastic; Blood Transfusion; Chelation Therapy; Combined Modality Therapy; Deferoxamine; Erythrocyte Count; Erythropoietin; Female; Follow-Up Studies; Hemochromatosis; Humans; Male; Myelodysplastic Syndromes; Primary Myelofibrosis; Recombinant Proteins; Remission Induction; Transfusion Reaction; Treatment Outcome

Topics: Adult; Aged; Blood Transfusion; Blood Transfusion, Autologous; Cost-Benefit Analysis; Disease Transmission, Infectious; Erythrocyte Transfusion; Erythropoietin; Hip Prosthesis; Humans; Knee Prosthesis; Middle Aged; Transfusion Reaction

Topics: Blood Component Transfusion; Blood Donors; Blood Specimen Collection; Blood Transfusion; Bloodletting; Erythropoietin; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Risk Factors; Transfusion Reaction

Topics: Anemia; Erythropoietin; Hemosiderosis; Humans; Iron Chelating Agents; Transfusion Reaction

The purpose of this study was to estimate the costs and benefits of the use of recombinant human erythropoietin (epoetin) in the treatment of anaemia arising from chronic renal failure. A 5-nation study, using an identical research protocol, was carried out by groups in France, Germany, Italy, Spain and the UK to identify the costs of the use of epoetin, the resource savings generated by such treatment and the effects of this treatment on the quality of life of patients. The latter was measured using the Rosser matrix of disability-distress states. The results show that the use of epoetin can produce a competitive cost per quality-adjusted life-year (QALY) only in patients with serious incapacity. Use of epoetin in patients who are not transfusion dependent would be an expensive way of gaining health benefits, which would be achieved at considerable opportunity cost.

Topics: Anemia; Blood Transfusion; Cost-Benefit Analysis; Drug Evaluation; Drug Utilization; Erythropoietin; Europe; Humans; Kidney Failure, Chronic; Quality of Life; Recombinant Proteins; Renal Dialysis; Transfusion Reaction; Value of Life

Topics: Adult; Aged; Erythrocyte Transfusion; Erythropoietin; Female; Humans; Iron; Liver; Male; Middle Aged; Renal Dialysis; Transfusion Reaction

Topics: Acute Kidney Injury; Adult; Anemia; Erythropoietin; Female; Hemolysis; Humans; Postoperative Complications; Transfusion Reaction

Topics: Antibodies; Antibody Formation; Erythropoietin; Female; Humans; Recombinant Proteins; Renal Dialysis; Transfusion Reaction

Topics: Blood Donors; Blood Transfusion, Autologous; Contraindications; Erythropoietin; Health Services Misuse; Humans; Neoplasm Recurrence, Local; Neoplasms; Recombinant Proteins; Risk Factors; Transfusion Reaction

Topics: Anemia; Antilymphocyte Serum; Erythropoietin; Humans; Renal Dialysis; Transfusion Reaction

Retrospective studies have provided indirect evidence that allogeneic blood transfusion may adversely influence the prognosis of cancer patients. This effect may be prevented by using autologous blood transfusions. However, this involves preoperative donation of blood, the consequences of which are still unknown. The aim of the present study was to investigate the possible effects of blood loss on tumour growth and on NK-cell activity. An artificial lung metastasis model was used in the BN rat from which 20 per cent of the blood volume was taken at different time intervals. The results showed that blood loss, one day prior to tumour challenge, had a profound stimulating effect on tumour growth. After blood loss, the number of lung metastases was doubled as compared to controls. This tumour-promoting effect could be prevented by an immediate plasma transfusion, but not by evoking a normal haemoglobin level after blood loss by pretreatment with recombinant erythropoietin (rEpo). The NK-cell activity of spleen cells was significantly depressed, 24 hours after blood loss. At a 50:1-lymphocyte-to-target cell ratio, the NK-cell activity dropped from 25.3 per cent in controls to 9.3 per cent in experimental animals. Since NK-cells are assumed to play a role in the clearance of tumour cells from the circulation, the enhanced tumour growth observed after blood loss might be caused by this depression.

Topics: Animals; Cell Division; Erythropoietin; Hemorrhage; Killer Cells, Natural; Male; Neoplasms, Experimental; Rats; Rats, Inbred BN; Recombinant Proteins; Transfusion Reaction

Transfusion therapy has been the mainstay for treating the anemia of end-stage renal disease (ESRD). Recently, several factors, including the awareness of associated risks, especially the transmission of blood-borne diseases and the transient treatment effect with regard to reversal of anemic symptoms, have caused a reassessment of transfusion therapy. Recombinant human erythropoietin (epoetin) has emerged as the alternative treatment, capable of sustained reversal of anemia without the associated risks of transfusions. The result of epoetin therapy has been marked improvement in the quality of life of ESRD patients. However, the advent of this therapy has also changed the nurse's role in caring for ESRD patients, as new medical management issues are identified and supportive care is tailored to the individual patient.

Topics: Anemia; Blood Transfusion; Education, Nursing, Continuing; Erythropoietin; Humans; Kidney Failure, Chronic; Patient Education as Topic; Quality of Life; Transfusion Reaction

A 41-year-old hemodialyzed woman developed ascites and was found to have secondary iron overload. The dose of administered iron was approximately 11-12 g, and her serum ferritin level was 15,000 ng/ml (15,000 micrograms/l). There were no signs of congestive heart failure, fluid overload, or liver cirrhosis. A program of weekly phlebotomy combined with recombinant human erythropoietin (rhEPO) therapy was tried to eliminate the iron congestion. After 9 months of this therapy, about 5 g of iron had been removed. The ascites completely disappeared, and her serum ferritin level fell to 5,800 ng/ml (5,800 micrograms/l). This suggests that such combined therapy would be useful when iron overload must be corrected rapidly. Before therapy, the sterile ascitic fluid showed exudative characteristics with 3.7 g/dl (37 g/l) of total protein. The serum-ascites albumin difference was 0.6 g/dl (6 g/l), and the fluid contained 1,400 inflammatory cells/mm3 (1.4 X 10(9)/l). Notably, the serum-ascites albumin difference increased in parallel with iron elimination. These findings suggested that iron deposition may have played a role in changing the permeability of the peritoneum, or in impairing lymphatic drainage, both of which are presumed to be pathogenetic factors of nephrogenic ascites.

Topics: Adult; Ascites; Bloodletting; Erythropoietin; Female; Hemochromatosis; Humans; Iron; Kidney Failure, Chronic; Renal Dialysis; Transfusion Reaction

Five long-term hemodialysis patients with clinical iron overload were treated with 300 U/kg of recombinant human erythropoietin (rHuEPO) intravenously (IV) after each hemodialysis. The patients were phlebotomized after each hemodialysis at any time the predialysis hematocrit was 35% or greater. Over a period of 1 year, the average phlebotomy rate varied from 0.5 to 1.1 U/wk with a mean phlebotomy rate of 45.8 +/- 5.6 U/yr (range, 27 to 57 U). The mean serum ferritin decreased from 8,412 +/- 1,599 micrograms/L (ng/mL) to 3,007 +/- 1,129 micrograms/L (ng/mL), and the mean iron removal over this period was 9.5 g. Liver iron deposition, as measured by density on computed tomographic (CT) scan, improved, while skin color lightened significantly. Patients tolerated phlebotomy with no major symptoms or complications and exhibited no change in the hemogram or serum chemistries. In patients with severe iron overload, changes in serum ferritin with erythropoietin treatment alone may not reflect true change in iron burden. Use of high-dose erythropoietin and phlebotomy is an effective and safe (at least for 1 year) method of reducing iron overload in long-term hemodialysis patients.

Topics: Adult; Bloodletting; Erythropoietin; Female; Ferritins; Hemosiderosis; Humans; Iron; Male; Middle Aged; Recombinant Proteins; Renal Dialysis; Time Factors; Transfusion Reaction

Topics: Adult; Blood Pressure; Erythropoietin; Glomerulonephritis; Humans; Male; Middle Aged; Nephrectomy; Peritoneal Dialysis, Continuous Ambulatory; Recombinant Proteins; Renal Dialysis; Seizures; Transfusion Reaction

Five patients undergoing long-term hemodialysis with transfusional iron overload received treatment for 18 weeks with a regimen of recombinant human erythropoietin (150 U/kg) and regular phlebotomy to maintain the hematocrit value at 25% and reduce the total body iron burden. In the 149 phlebotomy sessions performed in these patients, a mean of 228 +/- 8 ml (mean +/- SEM) of whole blood was removed; it had a hematocrit value of 27.7% +/- 0.2%. The iron content of the erythrocytes removed (erythrocyte iron concentration, 787 +/- 11 micrograms/ml in 133 samples) accounted for more than 99% of the total iron removal by phlebotomy. Serum iron (serum iron concentration, 1.57 +/- 0.09 micrograms/ml in 65 samples) accounted for an insignificant fraction of the total iron removed. The iron removed at each phlebotomy session averaged 49.1 +/- 2.0 mg, similar to the amount of iron removed with deferoxamine administration in patients undergoing dialysis who had iron overload, but without the potential for adverse side effects reported with long-term deferoxamine therapy. Total iron removal during the 18 weeks of this study ranged from 732 to 2797 mg. Mean serum ferritin level decreased from 3189 +/- 1076 micrograms/L to 1676 +/- 342 micrograms/L (p less than 0.02, Wilcoxon signed rank test). When compared with a group of five patients without transfusional iron overload who received recombinant human erythropoietin and did not undergo therapeutic phlebotomy, the patients with iron overload had much greater iron losses and a larger decrease in serum ferritin levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Bloodletting; Deferoxamine; Erythropoietin; Female; Ferritins; Hematocrit; Humans; Iron; Male; Middle Aged; Recombinant Proteins; Renal Dialysis; Transfusion Reaction

The erythropoietic response, measured as RBC-59Fe uptake after 24 h-exposure to hypoxia, were determined in posthypoxic, "acute" and "chronic" hypertransfused, and posthypoxic-hypertransfused mice. Radioiron uptake by erythrocytes was about 25 times greater in post-hypoxic than in both types of hypertransfused mice. Posthypoxic-hypertransfused mice showed an erythropoietic response to hypoxia which was not significantly different from that of posthypoxic mice and about 20 times greater than those of "acute" and "chronic" hypertransfused mice. When hypertransfused mice were exposed to hypoxia before transfusions, a linear increase in 59Fe uptake values in response to hypoxia was observed with exposures between 6 and 30 h. No further increase was observed for exposures of 46 to 216 h. These results suggest a sensitization of the erythropoietin-producing organ(s) by hypoxia.

Topics: Animals; Blood Transfusion; Erythropoiesis; Erythropoietin; Female; Hypoxia; Iron; Mice; Mice, Inbred Strains; Polycythemia; Time Factors; Transfusion Reaction

Topics: Acute Kidney Injury; Adolescent; Adult; Animals; Blood Proteins; Erythropoiesis; Erythropoietin; Female; Humans; Hypoxia; Male; Mice; Middle Aged; Polycythemia; Transfusion Reaction

An 18-yr-old female with chronic active hepatitis developed a severe anemia due to a lack of red cell production. Her bone marrow showed many large proerythroblasts but an almost complete lack of more mature erythroblasts. Incubation of the marrow cells in a normal medium with erythropoietin concentrate led to increased erythropoiesis as indicated by the development of mature erythroblasts as well as a ninefold increase in hemoglobin synthesis. The patient's plasma was cytotoxic for erythroblasts. Following splenectomy, a remission of the disease occurred. This study indicates that in some cases the anemia associated with abundant marrow proerythroblasts and the absence of mature erythroblasts has the same pathogenesis as pure red cell aplasia and that splenectomy may be beneficial when there is a lack of response to immunosuppressive drugs.

Topics: Adolescent; Anemia, Aplastic; Autoantibodies; Bone Marrow Cells; Bone Marrow Examination; Cells, Cultured; Cyclophosphamide; Cytotoxicity Tests, Immunologic; Erythroblasts; Erythrocytes; Erythropoietin; Female; Hemoglobins; Hemosiderosis; Hepatitis B; Humans; Immunosuppression Therapy; Iron; Iron Radioisotopes; Karyotyping; Liver Function Tests; Prednisone; Splenectomy; Transfusion Reaction

Topics: Agranulocytosis; Anemia, Aplastic; Anemia, Macrocytic; Bone Marrow Examination; Bone Neoplasms; Breast Neoplasms; Dihydrotestosterone; Erythropoiesis; Erythropoietin; Female; Hepatitis; Humans; Iron; Iron Radioisotopes; Male; Oxymetholone; Prednisolone; Sepsis; Transfusion Reaction

Topics: Acute Kidney Injury; Adolescent; Adult; Erythrocyte Count; Erythropoietin; Female; Hemoglobins; Humans; Male; Middle Aged; Transfusion Reaction; Urea

Topics: Animals; Erythropoiesis; Erythropoietin; Iron Isotopes; Mice; Polycythemia; Transfusion Reaction; Triiodothyronine

Topics: Animals; Erythrocytes; Erythropoiesis; Erythropoietin; Hypoxia; Iron; Mice; Polycythemia; Transfusion Reaction