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Patient Blood Management in Major Orthopedic Surgery: Less Erythropoietin and More Iron?

Rineau, Emmanuel MD*; Stoyanov, Alexandra MD*; Samson, Emmanuel MD*; Hubert, Laurent MD; Lasocki, Sigismond MD, PhD*

doi: 10.1213/ANE.0000000000002086
Blood Management: Brief Report

Erythropoietin (EPO) is proposed preoperatively to reduce blood transfusion in anemic patients (hemoglobin < 13 g/dL) scheduled for a major orthopedic surgery. New intravenous iron formulations allow infusion of higher doses, increasing EPO response. In that context, we evaluated in a before-after study (n = 62 and 65 patients for each period) a new EPO administration protocol (2 injections 4 and 3 weeks before surgery, and a third if hemoglobin <13 g/dL instead of <15 g/dL 2 weeks before surgery). After this protocol implementation, the mean (standard deviation) number of EPO injections decreased from 2.8 (0.5) to 2.2 (0.4)/patient (P < .0001) without changing transfusion rates (3% in the 2 periods).

Published ahead of print May 12, 2017.

From the *Département d’Anesthésie-Réanimation and Département de Chirurgie Osseuse, CHU d’Angers, Angers, France.

Accepted for publication February 17, 2017.

Published ahead of print May 12, 2017.

Funding: This work was solely supported by the University Hospital of Angers, France.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Emmanuel Rineau, MD, Département d’Anesthésie-Réanimation, CHU d’Angers, 4 rue Larrey, 49933 Angers Cedex 9, France. Address e-mail to

© 2017 International Anesthesia Research Society
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