The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Postoperative High-Dose Intravenous Iron Sucrose with Low Dose Erythropoietin Therapy after Total Hip Replacement

  • Yoon, Ji-Yeol (Department of Internal Medicine, Himchan Hospital) ;
  • Kim, Sung-Min (Department of Orthopedic Surgery, Himchan Hospital) ;
  • Lee, Soo-Chan (Department of Orthopedic Surgery, Himchan Hospital) ;
  • Lim, Hong-Sub (Department of Internal Medicine, Himchan Hospital)
  • Received : 2007.09.28
  • Accepted : 2007.10.31
  • Published : 2010.12.01
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Abstract

Erythropoietin combined with parenteral iron sucrose therapy is an alternative to blood transfusion in anemic patients. It was shown to be effective in surgical patients in several previous studies when used in conjunction with other methods. However, there are no guidelines about safety limits in dosage amounts or intervals. In this study, we report a case of significant postoperative hemorrhage managed with high dose parenteral iron sucrose, low dose erythropoietin, vitamin $B_{12}$, vitamin C, and folic acid. An 80-year-old female patient presented for severe anemia after a total hip arthroplasty and refused an allogenic blood transfusion as treatment. The preoperative hemoglobin of 12.2 g/dL decreased to 5.3 g/dL postoperatively. She received the aforementioned combination of iron sucrose, erythropoietin, and vitamins. A total of 1,500 mg of intravenous iron sucrose was given postoperatively for 6 consecutive days. Erythropoietin was also administered at 2,000 IU every other day for a total of 12,000 IU. The patient was discharged in good condition on the twelfth postoperative day with a hemoglobin of 8.5 g/dL. Her hemoglobin was at 11.2 g/dL on the twentieth postoperative day.

Keywords

References

  1. Klein HG. Allogeneic transfusion risks in the surgical patient. Am J Surg 1995;170(6A Suppl):21S-26S. https://doi.org/10.1016/S0002-9610(99)80054-3
  2. Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion 2003;43:459-469. https://doi.org/10.1046/j.1537-2995.2003.00348.x
  3. Cuenca J, Garcia-Erce JA, Martínez F, Perez-Serrano L, Herrera A, Munoz M. Perioperative intravenous iron, with or without erythropoietin, plus restrictive transfusion protocol reduce the need for allogeneic blood after knee replacement surgery. Transfusion 2006;46:1112-1119. https://doi.org/10.1111/j.1537-2995.2006.00859.x
  4. Garcia-Erce JA, Cuenca J, Martinez F, Cardona R, Perez-Serrano L, Munoz M. Perioperative intravenous iron preserves iron stores and may hasten the recovery from post-operative anaemia after knee replacement surgery. Transfus Med 2006;16:335-341. https://doi.org/10.1111/j.1365-3148.2006.00682.x
  5. Billote DB, Glisson SN, Green D, Wixson RL. A prospective, randomized study of preoperative autologous donation for hip replacement surgery. J Bone Joint Surg Am 2002;84:1299-1304. https://doi.org/10.2106/00004623-200208000-00002
  6. Atabek U, Alvarez R, Pello MJ, et al. Erythropoetin accelerates hematocrit recovery in post-surgical anemia. Am Surg 1995;61:74-77.
  7. Schwenk MH, Blaustein DA. Rapid, high-dose intravenous iron sucrose therapy in 2 Jehovah's Witness patients with severe anemia, iron deficiency and chronic kidney disease. Clin Nephrol 2004;62:116-120. https://doi.org/10.5414/CNP62116
  8. Aronoff GR, Bennett WM, Blumenthal S, et al. Iron sucrose in hemodialysis patients: safety of replacement and maintenance regimens. Kidney Int 2004;66:1193-1198. https://doi.org/10.1111/j.1523-1755.2004.00872.x
  9. Fletes R, Lazarus JM, Gage J, Chertow GM. Suspected iron dextran-related adverse drug events in hemodialysis patients. Am J Kidney Dis 2001;37:743-749. https://doi.org/10.1016/S0272-6386(01)80123-2
  10. Macdougall IC, Roche A. Administration of intravenous iron sucrose as a 2-minute push to CKD patients: a prospective evaluation of 2,297 injections. Am J Kidney Dis 2005;46:283-289. https://doi.org/10.1053/j.ajkd.2005.04.032
  11. Goodnough LT, Monk TG, Andriole GL. Erythropoietin therapy. N Engl J Med 1997;336:933-938. https://doi.org/10.1056/NEJM199703273361307
  12. Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood 2003;102:783-788. https://doi.org/10.1182/blood-2003-03-0672
  13. Ganz T. Hepcidin: a regulator of intestinal iron absorption and iron recycling by macrophages. Best Pract Res Clin Haematol 2005;18:171-182. https://doi.org/10.1016/j.beha.2004.08.020
  14. Brines M, Cerami A. Discovering erythropoietin's extrahematopoietic functions: biology and clinical promise. Kidney Int 2006;70:246-250. https://doi.org/10.1038/sj.ki.5001546
  15. Corwin HL, Gettinger A, Fabian TC, et al. Efficacy and safety of epoetin alfa in critically ill patients. N Engl J Med 2007;357:965-976. https://doi.org/10.1056/NEJMoa071533
  16. Zarychanski R, Turgeon AF, McIntyre L, Fergusson DA. Erythropoietin-receptor agonists in critically ill patients: a metaanalysis of randomized controlled trials. CMAJ 2007;177:725-734. https://doi.org/10.1503/cmaj.071055
  17. Fliser D, Haller H. Erythropoietin and treatment of non-anemic conditions: cardiovascular protection. Semin Hematol 2007;44:212-217. https://doi.org/10.1053/j.seminhematol.2007.04.008
  18. Sturm B, Laggner H, Ternes N, Goldenberg H, Scheiber- Mojdehkar B. Intravenous iron preparations and ascorbic acid: effects on chelatable and bioavailable iron. Kidney Int 2005;67:1161-1170. https://doi.org/10.1111/j.1523-1755.2005.00183.x
  19. Shiga T, Wajima Z, Inoue T, Sakamoto A. Aprotinin in major orthopedic surgery: a systematic review of randomized controlled trials. Anesth Analg 2005;101:1602-1607.
  20. Kourtzis N, Pafilas D, Kasimatis G. Blood saving protocol in elective total knee arthroplasty. Am J Surg 2004;187:261-267. https://doi.org/10.1016/j.amjsurg.2003.11.022

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