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Meta-Analysis
. 2020 Jan;99(2):e18577.
doi: 10.1097/MD.0000000000018577.

Use of preoperative erythropoietin therapy to facilitate autologous blood donation in orthopedic surgery: A meta-analysis

Xiao Chang  1 , Qiyi Li, Huang Tang
Affiliations
Meta-Analysis

Use of preoperative erythropoietin therapy to facilitate autologous blood donation in orthopedic surgery: A meta-analysis

Xiao Chang et al. Medicine (Baltimore). 2020 Jan.

Abstract

Background: Autologous blood transfusion helps to avoid or reduce the need for allogenic blood transfusion in patients undergoing major surgery. We examined the value of erythropoietin therapy to support preoperative autologous blood donation (PABD) in patients undergoing orthopedic surgery.

Methods: For this systematic review and meta-analysis, Medline, Cochrane, EMBASE, and Google Scholar databases were searched from October 26th, 1989 until September 30th, 2017. Primary outcomes were percentages of patients able to donate ≥4 units of blood for autologous transfusion, amount of allogeneic blood transfused, changes in hematocrit and hemoglobin levels from before PABD to immediately before surgery, and adverse events.

Results: Of 256 studies identified, 18 studies met the inclusion criteria with a total of 1914 patients (mean age 51-69 years), of whom 1153 were treated with erythropoietin. Erythropoietin was associated with a greater percentage of patients able to donate ≥4 units of blood for autologous use compared to controls (OR = 6.00, 95% CI = 3.97 to 9.09, P < .001). Patients receiving preoperative erythropoietin had significantly less of a reduction in hematocrit and hemoglobin levels from before PABD to immediately before surgery compared with controls (hematocrit: mean differences = -1.438, 95% CI = -2.14 to -0.73, P < .001; hemoglobin: mean differences = -1.426, 95% CI = -1.78 to -1.07, P < .001). No significant differences were observed in the amount of allogenic blood transfused between patients receiving erythropoietin and controls (difference in means = -0.220, 95% CI = -0.536 to 0.097, P = .174). Patients who received erythropoietin were less likely to experience dizziness than controls, but the incidence of nausea or fatigue were similar between groups.

Conclusion: Erythropoietin therapy during the PABD period results in less of a reduction in hematocrit and hemoglobin levels and an increase in the percentage of patients able to donate blood preoperatively.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Meta-analysis of percentage of patients able to donate ≥4 units of blood for autologous transfusion. CI = confidence intervals.
Figure 3
Figure 3
Meta-analysis of changes in hematocrit and hemoglobin from before PABD to immediately before surgery. CI = confidence intervals.
Figure 4
Figure 4
Meta-analysis of amount of allogeneic blood transfused. CI = confidence intervals.
Figure 5
Figure 5
Meta-analysis of adverse events of (A) nausea, (B) fatigue, and (C) dizziness.
See this image and copyright information in PMC

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References

    1. Hart S, Cserti-Gazdewich CM, McCluskey SA. Red cell transfusion and the immune system. Anaesthesia 2015;70: Suppl 1: 38–45. e13-36. - PubMed
    1. Goodnough LT, Shander A. Current status of pharmacologic therapies in patient blood management. Anesth Analg 2013;116:15–34. - PubMed
    1. García-Erce JA, Muñoz M, Bisbe E, et al. Predeposit autologous donation in spinal surgery: a multicentre study. Eur Spine J 2004;13: Suppl 1: S34–9. - PMC - PubMed
    1. Kickler TS, Spivak JL. Effect of repeated whole blood donations on serum immunoreactive erythropoietin levels in autologous donors. JAMA 1988;260:65–7. - PubMed
    1. Goodnough LT, Brittenham GM. Limitations of the erythropoietic response to serial phlebotomy: implications for autologous blood donor programs. J Lab Clin Med 1990;115:28–35. - PubMed