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Erythropoietin Reduces Transfusions, Increases Haemoglobin in the Critically Ill
Journal of the American Medical Association (JAMA)
12/11/2002
By Elda Hauschildt
Weekly administration of 40,000 units of recombinant human erythropoietin (rHuEPO) reduces allogeneic red blood cell (RBC) transfusion and increases haemoglobin in critically ill patients.
Researchers in the United States say further research is needed to determine, however, whether the reduction in RBC transfusion results in improved clinical outcomes in the critically ill.
"Despite receiving fewer RBC transfusions, patients treated with rHuEPO achieve a higher haemoglobin level, consistent with the hypothesis that the anaemia of critical illness is an underproduction anaemia characterized in part by a relative erythropoietin deficiency," say investigators led by Dr. Howard Corwin of the Dartmouth-Hitchcock Medical Centre in Lebanon, New Hampshire.
"No differences in clinical outcomes were demonstrated between rHuEPO and placebo groups. Therefore, while it is clear that rHuEPO treatment reduces RBC transfusions in critically ill patients, further study is necessary to establish whether this reduction will also result in improved clinical outcomes for some critically ill patients."
Sixty five US institutions participated in the randomised, controlled trial between December 1998 and June 2001. Enrolment included 1,302 critically ill patients treated in an intensive care unit (ICU) for two days and expected to remain there for two more days.
A group of 650 patients was randomised to rHuEPO while 652 patients received placebo.
Either rHuEPO or placebo was administered by subcutaneous injection on the third ICU day. Administration continued weekly for those who remained hospitalised, to a total of three doses. Patients still in ICU on day 21 received a fourth dose.
Patients randomised to rHuEPO were less likely to undergo transfusion (50.5 percent) than patients receiving placebo (60.4 percent). Those in the rHuEPO group had a 19 percent reduction in total units of RBCs transfused. They had a reduction in RBC units transfused per day alive, with a ratio of transfusion rates of 0.81.
Patients receiving rHuEPO also had a greater increase in haemoglobin from baseline compared with placebo patients.
Mortality was 14 percent for rHuEPO patients and 15 percent for placebo patients. There was no significant difference between the two groups in adverse clinical events either, the researchers note.
JAMA, 2002; 288: 2827-2835.
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