Erythropoietin in the perioperative setting: necessity or luxury?

Sanda-Maria Copotoiu

Universitatea de Medicină şi Farmacie Tg. Mureş, Clinica de Anestezie Terapie Intensivă nr. 1

Abstract

Erythropoietin (EPO) is a hormokine released by the kidney in response to a decrease in oxygen tension. It is known that EPO stimulates the erythroid progenitor cells in the bone marrow modulating the survival and prolipheration of the erythroid colony forming units, thus stimulating the prolipheration of the rheticulocytes. EPO is credited also for an anti-apoptotic effect exerted on erythroid progenitor cells, but also for some nonerythroid effects on the brain or for angiogenesis of the lean muscles, etc. The overall effect opposes anemia. This is why it’s use in reducing transfusions of the critically ill patients, but also pre- and postoperatively was highly promoted. Specific indications for EPO are patients suffering of chronic kidney disease (dialysed or not), HIV or AIDS patients on zidovudine, or anemic patients affected by cancer, where anemia was attributed to chemotherapy. With the aim of reducing allogenic red cells transfusion, but merely as a consequence of transfusion refusal by Jehova’s witnesses, human recombinant EPO (rHuEPO) was indicated preoperatively to prevent postoperative anemia in patients scheduled for cardiovascular, urologic surgery, total hip or knee replacement or plastic surgery where important blood loss was anticipated. However, evidence is still conflicting and not convincing about the real need of preoperative EPO as a routine. Health insurance companies draw up a clear picture of reimbursements, while pharmacoeconomic studies are ongoing.
 
Keywords: EPO, anaemia, transfusion, surgery

Eritropoietina în perioada perioperatorie: necesitate sau lux?