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DGDispatch
Erythropoietin Protocol Spares Red-Blood-Cell Transfusions in Anaemic Intensive-Care Patients: Presented at ASHP
By Paula Moyer
SAN DIEGO, CA -- June 9, 2003 -- Critically ill anaemic patients require fewer transfusions of red blood cells if a protocol is in place for the administration of erythropoietin in the intensive care unit (ICU), according to research results presented here on June 5th at the Annual Meeting of the American Society of Health-System Pharmacists.
"We wanted to see if a protocol would result in fewer transfusions," said Kathryn A. Rice, PharmD, a pharmacy practice resident at Methodist University Hospital, in Memphis, Tennessee. "After one was in place, our rate of red-blood-cell transfusions was reduced by 46%."
The investigators were motivated because of transfusion-associated risks and the limited supply of blood products. Previous research had shown that exogenous erythropoietin increases reticulocyte count and decreases the need for blood transfusions in ICU patients. In this previous research, patients had also received iron, folic acid, and vitamin B12 supplements.
To determine if these results could be replicated, Dr. Rice and her colleagues reviewed erythropoietin-prescribing patterns at their hospital for critically ill patients. They found several inconsistencies in the prescribing of supplemental medications and inadequate monitoring to assess the clinical effect of treatment. "We couldn't tell if giving erythropoietin was doing any good," Dr. Rice explained.
The researchers observed the use of erythropoietin in 26 treated patients in the ICU, and compared those results to the records of 652 controls. The investigators excluded patients on dialysis, those who had been diagnosed with cancer, those receiving zidovudine for human immunodeficiency virus, those scheduled for surgery, and those who were using erythropoietin for indications other than its transfusion-sparing effect.
The protocol group received 40,000 units of erythropoietin weekly, in two doses, as well as at least 150 mg of intravenous iron daily, 1 mg of folic acid, and a multivitamin. The investigators conducted a complete blood count with differential twice weekly, a reticulocyte count every other week, and a ferritin and iron profile every third week.
The investigators found that the protocol patients received an average of 1.9 units of red blood cells compared to 3 units in the control group.
"As a result of these findings, we developed a protocol for prescribing erythropoietin in combination with supplements," Dr. Rice said. "It allows the treatment to be used by the current main prescribers of erythropoietin for anaemia of critical illness."
Due to the high cost of the treatment, institutions need to take steps to ensure that only patients expected to benefit from erythropoietin receive it, Dr. Rice added.
[Study title: Evaluation Of An ICU-Based Erythropoietin Protocol. Abstract P-14]
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