Effects Of Intravenous Iron Combined With Recombinant Human Erythropoietin On Transfusion Requirements In Preoperative Gynecological Anemia Patients

Objective This clinical investigation was to estimate the efficacy of recombinant human erythropoietin (rHuEPO, Epoetin-alfa) with iron supplement in attenuating the gynecological iron deficiency anemia and reducing allogeneic blood transfusion requirements (BTR) in those patients.Methods Having been approved by the hospital ethics committee and after signing an informed consent, Sixty gynecological anemia patients (7Og/L=hemoglobin(Hb)=100g/L) scheduled for elective surgery in our hospital from August1st-November30th,2012, entered the study, and they were randomly divided into two groups with30cases in eachrGroup C (control) or Group IE (iron sucrose intravenously and5000IU of rHuEPO subcutaneously on4days before surgery and the surgery day). Surgeryis divided into myomectomy24cases,Uterinepartial resectionin22cases,hysterectomyl4cases.The inclusion criteria into the study included:no significantheart、kidney、liver disease, non-allergic constitution and voluntary treatment,uterine fibroids require gynecological surgery,estimated blood loss<400ml,aged28to55years,preoperative7O g/L=hemoglobin(Hb)=100g/L。Exclusion criteria were:EPO allergy, uncontrolled hypertension (blood pressure>160/110mmHg), obviously hyperparathyroidism performers, a variety of acute and chronic infection, chronic wasting disease, chronic renal insufficiency or liver renal syndrome, intraoperative bloodloss>400mlPeri-operative hemoglobin (Hb) levels determined whether the allogeneic blood transfusion was needed.In the operating room and recovery room,anesthesiologists decided whether blood transfusion needed;in the ward,the surgeon decided. Little white erythrocytesin puting guidelines applied to every patient(regardless of category):one unit of red blood cells needed when Hb at70-79g/L, and two units of red blood cells needed when Hb60-69g/L,however, we should transfused patients if their Hb drops to60g/L or they developed severe anemia clinical symptoms(such as hypotension, tachycardia, shortness of breath, dizziness, weakness,etc.),and the patiends should be removed。We recorded the laboratory examination [including hemoglobin (Hb), hematocrit (Hct), reticulocyte percentage (RET%),red blood count (RBC), serum ferritin (SF)]and related complications on4days before surgery (-4), the surgery day(0),1day after surgery (+1),3days after surgery(+3) and5days after surgery (+5). The allogeneic blood transfusion requirement was recorded. We followed up the patients of Experimental group and recorded the hemoglobin levels one month later.Results The peri-operative Hb levels and blood transfusion requirements of the two groups was comparable. The Hb、Hct、RET%levels of patients in Experimental group increased significantly on days0,+1,+3,+5than that of the Control group (P<0.01) After operation, serum ferritin (SF) in Experimental group was significantly higher than that in the Control group (P<0.01). Only two units allogeneic blood was required in the IE Group which may calculated to an average consumption of0.07blood unit per person, compared with20blood units used in the Control group,0.67blood units per person. So allogeneic blood transfusion requirements in Experimental group reduced significantly than that of in Control group (P<0.01)Conclusion The combined application of rHuEPO with iron supplement can improve the peri-operative anemia effectively and avoid or reduce the allogeneic blood transfusion. We found rHuEPO administration have no postoperative complications such as embolic events one month after the operation.