The Efficacy of Preoperative Administration of a Single Dose of Recombinant Human Erythropoietin in Pediatric Cardiac Surgery
DOI:
https://doi.org/10.1532/HSF98.20061183Abstract
Background. Preoperative autologous blood donation with recombinant human erythropoietin (rHuEPO) is effective in adults. However, there are problems concerning the blood access, cost, and blood storage in children. The purpose of this study was to evaluate the efficacy of administering a single dose of rHuEPO without blood donation in children undergoing pediatric cardiac surgery.
Methods. Eighty-two children (72 with noncyanotic heart disease, and 10 with cyanotic heart disease) whose hematocrit values were less than 45% were included in this prospective, nonrandomized study. The children were divided into 3 groups: group E0 (n = 20) was not treated with rHuEPO and iron sulfate; group E2 (n = 27) was treated with 200 IU/kg of rHuEPO and 2 mg/kg of iron sulfate; and group E4 (n = 35) was treated with 400 IU/kg of rHuEPO and 4 mg/kg of iron sulfate. Administration of rHuEPO was performed subcutaneously 7 days before the operation. The hematological and iron parameters were measured perioperatively.
Results. A lower proportion of children treated with rHuEPO (group E2, 14.8%; group E4, 22.9%) than children without rHuEPO (group E0, 40.0%) were exposed to RBC transfusions; however, there was no significance. The elevations of the hematocrit levels were 0.7% in group E0, 1.3% in group E2, and 1.9% in group E4. The elevation of the hematocrit was greater in patients with anemia (hematocrit ?37%).
Conclusions. Although the effectiveness for avoiding transfusion was not clear, the administration of a single dose of rHuEPO without autologous blood donations had an effect by increasing hematocrit levels.
References
Bennett CL, Luminari S, Nissenson AR, et al. 2004. Pure red-cell aplasia and epoetin therapy. N Engl J Med 351:1403-8.nBidstrup BP, Royston D, Sapsford RN, et al. 1989. Reduction in blood loss and blood use after cardiopulmonary bypass with high dose aprotinin (Trasylol). J Thorac Cardiovasc Surg 97:364-72.nCook DJ, Orszulak TA, Daly RC, et al. 1997. Minimum hematocrit for normothermic cardiopulmonary bypass in dogs. Circulation 96:II200-4.nCoyle D, Lee KM, Fergusson DA, et al. 2000. Cost effectiveness of epoetin-alpha to augment preoperative autologous blood donation in elective cardiac surgery. Pharmacoeconomics 18:161-71.nD'Ambra MN, Gray RJ, Hillman R, et al. 1997. Effect of recombinant human erythropoietin on transfusion risk in coronary bypass patients. Ann Thorac Surg 64:1686-93.nDe Andrade JR, Jove M, Landon G, et al. 1996. Baseline hemoglobin as a predictor of risk of transfusion and response to epoetin alfa in orthopedic surgery patients. Am J Orthop 25:533-42.nEngoren MC, Habib RH, Zacharias A, et al. 2002. Effect of blood transfusion on long-term survival after cardiac operation. Ann Thorac Surg 74:1180-6.nFukahara K, Murakami A, Ueda T, et al. 1997. Scheduled autologous blood donation at the time of cardiac catheterization in infants and children. J Thorac Cardiovasc Surg 114:504-5.nHaga P, Cotes PM, Till JA, et al. 1987. Serum immunoreactive erythropoietin in children with cyanotic and acyanotic congenital heart disease. Blood 70:822-6.nHardy JF, Belisle S, Janvier G, et al. 1996. Reduction in requirements for allogeneic blood products: nonpharmacologic methods. Ann Thorac Surg 62:1935-43.nJacobs K, Shoemaker C, Rudersdorf R, et al. 1985. Isolation and characterization of genomic and cDNA clones of human erythropoietin. Nature 313:806-10.nKiyama H, Ohshima N, Imazeki T, et al. 1999. Autologous blood donation with recombinant human erythropoietin in anemic patients. Ann Thorac Surg 68:1652-6.nKuehnert MJ, Roth VR, Haley NR, et al. 2001. Transfusion-transmitted bacterial infection in the United States, 1998 through 2000. Transfusion 41:1493-9.nKurth CD, Steven JM, Nicolson SC, et al. 1997. Cerebral oxygenation during cardiopulmonary bypass in children. J Thorac Cardiovasc Surg 113:71-9.nMasuda M, Kawachi Y, Inaba S, et al. 1995. Preoperative autologous blood donations in pediatric cardiac surgery. Ann Thorac Surg 60:1694-7.nMichalopoulos A, Tzelepis G, Dafni U, et al. 1999. Determinants of hospital mortality after coronary artery bypass grafting. Chest 115:1598-603.nMiyake T, Kung CK, Goldwasser E. 1977. Purification of human erythropoietin. J Biol Chem 252:5558-64.nOotaki Y, Yamaguchi M, Oshima Y, et al. 2002. Effects of modified ultrafiltration on coagulation factors in pediatric cardiac surgery. Surg Today 32:203-6.nOotaki Y, Yamaguchi M, Yoshimura N, et al. 2004. Efficacy of a criterion driven transfusion protocol in pediatric cardiac surgery patients. J Thorac Cardiovasc Surg 127:953-8.nShimpo H, Mizumoto T, Onoda K, et al. 1997. Erythropoietin in pediatric cardiac surgery: clinical efficacy and effective dose. Chest 111:1565-70.nSowade O, Warnke H, Scigalla P, et al. 1997. Avoidance of allogeneic blood transfusions by treatment with epoetin beta (recombinant human erythropoietin) in patients undergoing open-heart surgery. Blood 89:411-8.nStrauss RG. 1994. Can the cost of erythropoietin for cardiac surgery patients be justified? Transfusion 34:835.nTyndall MR, Teitel DF, Lutin WA, et al. 1987. Serum erythropoietin levels in patients with congenital heart disease. J Pediatr 110:538-44.nWatanabe Y, Fuse K, Konishi T, et al. 1991. Autologous blood transfusion with recombinant human erythropoietin in heart operations. Ann Thorac Surg 51:767-72.nYazicioglu L, Eryilmaz S, Sirlak M, et al. 2001. Recombinant human erythropoietin administration in cardiac surgery. J Thorac Cardiovasc Surg 122:741-5.n
