Biology Reference
In-Depth Information
Use of erythropoietins in the surgical setting
Fred D. Cushner
Beth Israel Medical Center, 170 East End Avenue, New York, NY 10128, USA
Introduction
Modern conservation techniques have reduced the amount of blood lost during
surgery, but acute anemia resulting from blood loss during surgery remains a
problem and can cause severe damage to organs such as the heart, kidney,and
brain. Prolonged post-operative anemia may delay recovery from surgery,
leading to increased direct and indirect cost to the patient, healthcare
providers, and payers. While allogeneic blood transfusions have traditionally
been used to ameliorate the anemia of surgery,reducing exposure to allogene-
ic blood can reduce the risk of transmission of infections, allergic reactions,
transfusion reactions, or immunosuppression [1-5]. In addition, frequent red
blood cell transfusions with allogeneic blood may adversely effect the immune
system of patients with cancer, thereby increasing the tendency to develop
infections, hastening the time to relapse, or shortening survival [4-6].
Risk of infection
Nearly 50% of all anemic patients scheduled for single-joint replacement sur-
gery receive allogeneic red blood cell transfusions. The risk of allogeneic
transfusions is well described in the literature [7-13]. While often these con-
cerns have focused on the transfusion of viral agents such as human immun-
odeficiency virus (HIV) or hepatitis, newer concerns have been raised such as
West Nile virus transmission [14].
Allogeneic transfusions have been implicated in an increased incidence of
bacterial infection after surgery. Houbiers et al. [15] evaluated 697 patients
undergoing colorectal surgery in a randomized clinical trial. Multivariate
analysis identified the transfusion of red blood cells as a significant independ-
ent risk factor for post-operative bacterial infection (p < 0.01). Kendall et al.
[16] described immunosuppression secondary to allogeneic transfusions in 34
patients undergoing total hip arthroplasty. One of the goals of the study was to
determine whether allogeneic transfusions resulted in post-operative immuno-
suppression. The authors concluded that immunosuppression does occur and
