A Prospective Randomized Comparison of Three Blood Conservation Strategies for Radical Prostatectomy
| Autor: | Terri G. Monk, Mark E. Brecher, Lawrence T. Goodnough, William J. Catalona, Gerald L. Andriole, John W. Colberg |
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| Rok vydání: | 1999 |
| Předmět: |
Male
medicine.medical_specialty Blood transfusion medicine.medical_treatment Hematocrit Preoperative care Blood Transfusion Autologous medicine Humans Prospective Studies Prospective cohort study Erythropoietin Aged Prostatectomy Hemodilution medicine.diagnostic_test business.industry Epoetin alfa Middle Aged Recombinant Proteins Surgery Anesthesiology and Pain Medicine business Elective Surgical Procedure medicine.drug |
| Zdroj: | Anesthesiology. 91:24-33 |
| ISSN: | 0003-3022 |
| Popis: | Background Preoperative autologous blood donation is a standard of care for elective surgical procedures requiring transfusion. The authors evaluated the efficacy of alternative blood-conservation strategies including preoperative recombinant human erythropoietin (rHuEPO) therapy and acute normovolemic hemodilution (ANH) in radical retropubic prostatectomy patients. Methods Seventy-nine patients were prospectively randomized to preoperative autologous donation (3 U autologous blood); rHuEPO plus ANH (preoperative subcutaneous administration of 600 U/kg rHuEPO at 21 and 14 days before surgery and 300 U/kg on day of surgery followed by ANH in the operating room); or ANH (blinded, placebo injections per the rHuEPO regimen listed previously). Transfusion outcomes, perioperative hematocrit levels, postoperative outcomes, and blood-conservation costs were compared among the three groups. Results Baseline hematocrit levels were similar in all groups (43%+/-2%). On the day of surgery hematocrit decreased to 34% +/-4% in the preoperative autologous donation group (P < 0.001), increased to 47%+/-2% in the rHuEPO plus ANH group (P < 0.001), and remained unchanged at 43%+/-2% in the ANH group. Allogeneic blood exposure was similar in all groups. The rHuEPO plus ANH group had significantly higher hematocrit levels compared with the other groups throughout the hospitalization (P < 0.001). Average transfusion costs were significantly lower for ANH ($194+/-$192) compared with preoperative autologous donation ($690+/-$128; P < 0.001) or rHuEPO plus ANH ($1,393+/-$204, P < 0.001). Conclusions All three blood-conservation strategies resulted in similar allogeneic blood exposure rates, but ANH was the least costly technique. Preoperative rHuEPO plus ANH prevented postoperative anemia but resulted in the highest transfusion costs. |
| Databáze: | OpenAIRE |
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