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. 2025 Jan;23(1):28-32.
doi: 10.2450/BloodTransfus.971. Epub 2024 Dec 19.

Managing preoperative anemia: EPO is needed

Emmanuel Rineau  1   2 , Maëva Campfort  1   2 , Sigismond Lasocki  1   2
Affiliations

Managing preoperative anemia: EPO is needed

Emmanuel Rineau et al. Blood Transfus. 2025 Jan.
No abstract available

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Conflict of interest statement

CONFLICTS OF INTEREST: ER and SL received personal fees and non-financial support for conferences from CSL Vifor (Paris La Défense, France), Masimo (Neuchâtel, Swizterland) and Pfizer (Paris, France). SL received personal fees and non-financial support from Pharmacosmos (Holbaek, Denmark). ER received honoraria from the French National Authority for Health (HAS) as a project manager for drafting the 2022 French guidelines on perioperative blood management. MC declares that she has no conflicts of interest.

Figures

Figure 1
Figure 1
Proposal of a decision-making algorithm specifying the place of EPO in the management of preoperative anemia, based on research findings and recommendations 1. In a patient with cancer, a benefit-risk discussion regarding the use of EPO should take place, and it is currently suggested to avoid attempting to exceed a hemoglobin level of 12 g/dL with EPO, to limit the thrombotic risk. 2. In a patient with both low iron stores (ferritin <100 μg/L) and anemia of inflammation (C-reactive protein >5 mg/L and transferrin saturation <20%), an EPO treatment may be added if IV iron alone fails to reach the target hemoglobin level. 3. Other treatments depend on the cause of anemia (for example, folate or B12 deficiency). The diagnosis may require an anemia specialist referral. Of note, the cause of anemia should also be investigated in cases of EPO or iron treatment (e.g., gastrointestinal or gynecological bleeding). EPO: erythropoietin; IV: intravenous; TSAT: transferrin saturation.
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