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The effect of a preoperative erythropoietin protocol as part of a multifaceted blood management program in daily clinical practice (CME)
Author(s) -
Doodeman Hieronymus J.,
Haelst Ingrid M.M.,
Egberts Toine C.G.,
Bennis Martin,
Traast Han S.,
Solinge Wouter W.,
Kalkman Cor J.,
Klei Wilton A.
Publication year - 2013
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12016
Subject(s) - medicine , erythropoietin , blood management , confidence interval , blood transfusion , population , anemia , observational study , retrospective cohort study , environmental health
Background The effectiveness of a preoperative erythropoietin ( EPO ) protocol to reduce allogeneic blood transfusions ( ABTs ) in daily clinical practice has been insufficiently studied. This study evaluated the effect of such a protocol, as part of a multifaceted blood management program, in patients undergoing total hip arthroplasty ( THA ). Study Design and Methods This retrospective observational study was designed as an interrupted time series (1999‐2010). The intervention was the introduction of an EPO protocol in THA patients in 2003. Patients were classified according to preoperative hemoglobin ( H b) level: 10 to 13 g/ dL (eligible patients for EPO ) and more than 13 g/ dL . The primary outcome was the percentage of patients receiving an ABT . Segmented regression analysis was used to estimate changes in outcome after the intervention. Results A total of 4568 THA patients were included. The absolute reductions in ABTs after the intervention were 17% (95% confidence interval [ CI ], 6%‐29%) for the total study population and 25% (95% CI , 11%‐39%) and 8% (95% CI , −5% to 21%) for the H b groups 10 to 13 and more than 13 g/ dL , respectively. In the postintervention period, 46% of the eligible patients ( H b level, 10‐13 g/ dL ) actually received EPO . The transfusion rate in the EPO group was lower compared to the non‐ EPO group: 14 and 50%, respectively (p < 0.01). Conclusion Introduction of a preoperative EPO protocol reduced the transfusion rate in THA patients in daily clinical practice. The reduction must be seen as part of a multifaceted blood management program, in which increased awareness of blood transfusion contributes simultaneously and substantially to the reduction in transfusion rate.