Recombinant human erythropoietin and management of anemia in orthopedic surgery

Abstract

SUMMARYConcerns regarding the safety, supply and cost of allogeneic blood transfusion have led to the development of recombinant human erythropoietin (rHuEPO) for anemic patients. rHuEPO safely increases preoperative red blood cell production and reduces allogeneic transfusion. During the preoperative period, expected blood loss and patient medical status need to be evaluated to select those patients who can benefit from this therapy. The appropriate dose of rHuEPO is determined according to the patient’s baseline hematocrit. This therapy must be part of an overall management strategy for anemia with appropriate iron supplementation. rHuEPO is used in combination with other blood‐conservation techniques in revision arthroplasties and spine surgery, depending on expected blood loss. The benefits, risks and costs of these blood‐conservation techniques must be compared with those of allogeneic transfusion. For the future, the use of rHuEPO must continue to be developed in anemic patients undergoing orthopedic surgery.