Effects of intravenous iron combined with low‐dose recombinant human erythropoietin on transfusion requirements in iron‐deficient patients undergoing bilateral total knee replacement arthroplasty (CME)

Abstract

BACKGROUND: The authors examined the impact of parenteral iron and recombinant human erythropoietin-β (rHuEPO-β) administered in the bilateral total knee replacement arthroplasty (TKRA), on postoperative anemia and transfusion requirements in iron-deficient patients. STUDY DESIGN AND METHODS: A total of 108 iron-deficient patients were randomly assigned to two groups: Group C (control) or Group IE (200 mg of iron sucrose intravenously over 1 hr and 3000 IU of rHuEPO-β subcutaneously during the operation and during the postoperative period if the hemoglobin [Hb] level was 70-80 g/L). One or 2 units of blood were transfused to patients in both groups according to postoperative Hb level (between 60 and 70 g/L or betweeen 50 and 60 g/L, respectively). Perioperative laboratory and clinical outcomes (Hb, iron variables, postoperative bleeding amount, and number of units of RBCs transfused and incidences) were documented. RESULTS: Although preoperative Hb and the amount of postoperative bleeding were comparable in the two groups, Hb levels at 1, 2, and 3 days and at 2 and 6 weeks postoperation were significantly higher in Group IE. Furthermore, the transfusion rate was significantly lower in Group IE (20.4% vs. 53.7%, p=0.011) and the mean number of red blood cell units transfused was markedly lower in Group IE (0.2±0.5 vs. 0.8±0.8, p=0.005). Postoperative iron, ferritin, and transferrin saturation levels were significantly higher in Group IE. CONCLUSIONS: Treatment with parenteral iron and low-dose rHuEPO-β in bilateral TKRA effectively attenuated anemia and decreased transfusion requirements in iron-deficient patients.