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The effect of a preoperative erythropoietin protocol as part of a multifaceted blood management program in daily clinical practice.


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).
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 (Hb) 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.
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 Hb groups 10 to 13 and more than 13 g/dL, respectively. In the
postintervention period, 46% of the eligible patients (Hb 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).
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.
Transfusion. 2012 Dec 12. doi: 10.1111/trf.12016.