Use of Preoperative Erythropoetin in Children Undergoing Major Surgery to Reduce the Need for Allogenic Blood Transfusions † 770

Abstract

Despite impressive advances in the safety of blood products, the search for therapeutic alternatives to blood transfusions continues. Reinfusion of extravasated blood at surgery harvested using blood collectors, preoperative autologous blood donation and the use of pharmacological doses of recombinant erythropoetin (Epo) preoperatively have been used in adults to eliminate the need for transfusions. We administered Epo to three children (age 2 months, 6 years, 15 years) who were Jehovah's witnesses and were scheduled for major elective surgery (2 children had open heart surgery and one had scoliosis surgery). Epo was administered in the dose of 150 u/kg thrice weekly for six weeks to one patient and 500 u/kg twice weekly for three weeks to the other two. Iron supplementation (3 mg/kg) was also started concommitantly on the patients receiving the higher doses to optimize the response to Epo.There was a rise in hemoglobin by a mean of 4.1g/dl (2.3g/dl, 3.8g/dl, 6.3g/dl) and hematocrit increased by a mean of 14% (6.6%, 15.2%, 20.3%). WBC and platelet counts remained stable during the therapy. Higher and a more brisk response was observed in patients receiving the higher doses and iron supplements. Other than mild hypertension in one,which resolved when therapy was stopped, there were no other side effects observed. Postoperatively hemoglobin dropped by a mean of 6.1g/dl (3.4g/dl, 4.9g/dl, 10g/dl) and hematocrit decreased by a mean of 18%(8.7%, 15.1%, 29.8%). One patient received extravasated autologous blood harvested intraoperatively and none of the others required any blood products. The above experience indicates that preoperative Epo may provide a safe method to eliminate or at least minimize the need for blood products in children who undergo major elective surgery. Though there are many studies available in adults, larger studies are needed in children to determine the optimal dose, duration and limitations of Epo treatment. Further, the option of offering preoperative Epo therapy to all children undergoing major elective surgery needs to be explored.