Anemia Management: Erythropoietic Agents

Abstract

OBJECTIVE:

To validate previous findings of the effects of erythropoiesis-stimulating agent (ESA) administration following severe traumatic brain injury.

DESIGN:

Prospective observational study of all patients with severe traumatic brain injury admitted to the surgical intensive care unit (SICU) at our institution from January 1, 2009, to December 31, 2010 (head Abbreviated Injury Scale score ≥3). Propensity scores were calculated to match patients who received ESA within 30 days after admission to patients who did not receive ESA.

Abstract

PURPOSE:

To assess the clinical and economic outcomes among patients with chemotherapy-induced anemia (CIA) treated with United States Food and Drug Administration-approved fixed dosing regimens of erythropoiesis-stimulating agents (ESA).

METHODS:

Summary While several studies have evaluated recombinant human erythropoietin (EPO) in the treatment of refractory anemia in inflammatory bowel disease (IBD) this is the first treatment study to determine the effectiveness of the longer half-life agent darbepoetin-alpha (DPO). In a single center, open label, single arm study the investigators recruited 20 patients with confirmed IBD and who had anemia (Hb <10 g/dL for females and <11 g/dL in males) refractory to intravenous (IV) iron therapy.

Summary Alghamdi and colleagues conducted what they believe to be the largest systematic review to date to investigate the effectiveness of preoperative erythropoietin (EPO) in reducing allogeneic blood transfusion exposure in patients undergoing cardiac surgery. The primary outcome measure was the number of patients transfused with allogeneic blood during the hospital stay.

Summary This systematic review of 57 trials (involving 9,353 cancer patients) published between January 1985 and April 2005 updates an earlier review covering the period between January 1985 and December 2001 (Bohlius et al).

Summary This panel of international experts report on the broad impact of anemia on patients and the community. They refer to a WHO estimate that over 30% of the world’s population are anemic and 66-80% may be iron deficient.

Summary Garcia-Erce and colleagues have previously reported on a blood saving protocol utilizing perioperative intravenous (IV) iron and recombinant human erythropoietin (rHuEPO) in patients undergoing surgery for hip fracture (Carcia-Erce JA, et al).

Summary This multicenter randomized controlled trial investigated the use of recombinant human erythropoietin (rHuEPO) in patients who, following their acute critical illness, are discharged from the intensive care unit (ICU) and, because of their chronic critical illness, are admitted to a long-term acute care facility (LTAC).

Summary This multicenter (n=27) randomized, double-blind, placebo-controlled trial enrolled children with cancer (solid tumors, Hodgkin’s disease, acute lymphoblastic leukemia or non-Hodgkin’s lymphoma) and who were anemic and receiving myelosuppressive chemotherapy. The trial’s objective was to assess the effects of a once-weekly dose of epoetin alfa (EPO) on health-related quality of life (HRQOL), hemoglobin (Hb) levels and red blood cell (RBC) transfusions in this group of patients. Outcome measures also included adverse events.