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Blood Conservation in Neurosurgery: Erythropoietin and Autologous Donation

  • Alexander McGirr (a1) (a2), Katerina Pavenski (a3), Bhanu Sharma (a2) and Michael D. Cusimano (a1) (a4)
Abstract
Background

Neurosurgery may involve significant blood loss and frequently requires allogeneic red blood cell (RBC) transfusion. Preoperative recombinant erythropoietin (EPO) may be used to improve erythroid status and recovery, and used either alone or in combination with preoperative autologous donation (PAD) it may reduce exposure to allogeneic RBC. We wished to study the use of EPO with and without PAD and the risk of RBC transfusion in neurosurgery.

Methods

Using a retrospective case-control design, 57 patients who received EPO preoperatively were matched 2:1 for age, sex, year of surgery, and International Classification of Diseases code most responsible for surgery (three were excluded because of stringent matching criteria, leaving 54 cases and 108 comparison subjects). Thirty-two cases participated in PAD. Medical and anesthetic records as well as laboratory investigations were reviewed and extracted.

Results

Allogeneic RBC exposure was identical for EPO cases and comparison subjects (18.5%). Concomitant PAD and EPO did not reduce allogeneic RBC exposure (21.9%), and resulted in a greater number of RBC units transfused. Last recorded hemoglobin levels suggested that autologous RBCs were not more liberally used. Patients who engaged in PAD and EPO suffered from iatrogenic anemia. A significant proportion (58.6%) of the autologous RBCs was ultimately not used and discarded.

Conclusion

Further research is needed to determine the efficacy of EPO in neurological surgery. PAD does not appear to reduce the risk of allogeneic RBC transfusion, despite concomitant EPO. Indeed, PAD resulted in iatrogenic anemia and increased transfusion requirements. The cost-effectiveness of blood conservation efforts in neurosurgery deserves additional research.

Contexte

La neurochirurgie peut donner lieu à une perte de sang importante qui nécessite fréquemment le recours à la transfusion de globules rouges (GR) allogènes. L’étythropoïétine recombinante (EPO) en période préopératoire peut être utilisée pour améliorer le statut érythroïde et favoriser la guérison. Elle peut être utilisée seule ou combinée à un don autologue préopératoire (DAP) et ainsi diminuer l’exposition aux GR allogènes. Le but de l’étude était d’examiner l’utilisation d’EPO avec ou sans DAP et le risque de transfusion de GR en neurochirurgie.

Méthode

Il s’agit d’une étude rétrospective cas-témoin portant sur 57 patients qui ont reçu de l’EPO avant la chirurgie. Ils ont été appariés 2:1 pour l’âge, le sexe, l’année de la chirurgie et le motif de la chirurgie, identifié selon le code de la Classification internationale des maladies (3 patients ont été exclus à cause des critères rigoureux d’appariement). L’étude porte donc sur 54 patients et 108 témoins. Trente-deux patients ont eu recours à un DAP. Les dossiers médicaux et d’anesthésie ainsi que les examens de laboratoire ont été revus.

Résultats

L’exposition à des GR allogènes a été identique chez les patients ayant reçu de l’EPO et chez les sujets témoins (18,5%). L’administration de DAP et d’EPO n’a pas diminué l’exposition aux GR allogènes (21,9%) et a donné lieu à la transfusion d’un plus grand nombre d’unités de GR. La dernière valeur d’hémoglobine au dossier suggérait que les GR autologues n’étaient pas utilisés de façon plus libérale. Les patients qui avaient participé à un DAP et qui ont reçu de l’EPO ont souffert d’anémie iatrogène. Une proportion significative (58.6%) des GR autologues n’a pas été utilisée et ils ont été jetés.

Conclusion

Des recherches plus poussées seront nécessaires pour déterminer l’efficacité de l’EPO en neurochirurgie. Le DAP ne semble pas diminuer le risque de transfusion de GR allogènes malgré l’administration concomitante d’EPO. En effet, le DAP a mené à une anémie iatrogène et a augmenté le recours à la transfusion. Le rapport coût-efficacité des efforts de conservation du sang en neurochirurgie mérite qu’on l’étudie davantage.

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Copyright
Corresponding author
Correspondence to: Alexander McGirr, Injury Prevention Research, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, Canada, M5B 1W8. Email: alexander.mcgirr@alum.utoronto.ca, injuryprevention@smh.ca.
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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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