Hanyang Med Rev.  2018 Mar;38(1):16-26. 10.7599/hmr.2018.38.1.16.

A Paradigm Shift: Perioperative Iron and Erythropoietin Therapy for Patient Blood Management

• Lee H
• Yuh YJ

• KMID: 2407798
• DOI: http://doi.org/10.7599/hmr.2018.38.1.16

Abstract

Allogeneic blood transfusion is often restricted due to its adverse effects, a lack of blood supply, and religious or cultural constraints. As a result, patient blood management (PBM) has been gaining attention. PBM is an evidence-based, patient-centered bundle of technologies that manages perioperative anemia and reduces bleeding during surgery. PBM improves the postoperative prognoses. Perioperative anemia is the main concern in PBM; therefore, to diagnose and treat it is important. This review focuses on the perioperative use of oral or intravenous iron and erythropoietin (EPO), in relevant fields such as cardiac surgery, orthopedics, and neurosurgery. IV administration of iron has been controversial due to safety concerns, such as increased risk of infection. However, using IV iron appropriately is beneficial in most surgical settings. Although recombinant human EPO may increase thromboembolic risks, this can be mitigated through various methods including limiting the target Hb level, using it in combination with IV iron, or prophylaxis for deep venous thrombosis. EPO is recommended in patients undergoing cardiac or orthopedic surgery. As PBM becomes globally implemented, the blood management methods, including tranexamic acid, hemostatic agents, and cell salvage have become more variable as well. Among them, administration of iron and EPO would be the most common pharmacologic choices based on current practice. However, controversy still exists. Therefore, further studies on iron and EPO are needed to ensure better and safer patient care.

Keyword

Anemia; Iron; Erythropoietin; Bloodless medical and surgical procedures; Perioperative care

MeSH Terms

Anemia
Blood Transfusion
Bloodless Medical and Surgical Procedures
Erythropoietin*
Hemorrhage
Humans
Iron*
Neurosurgery
Orthopedics
Patient Care
Perioperative Care
Prognosis
Thoracic Surgery
Tranexamic Acid
Venous Thrombosis
Erythropoietin
Iron
Tranexamic Acid

Figure

• 

  Fig. 1 Expression of hepcidin that is influenced by some physiological conditions. This figure shows two different expression of hepcidin getting influenced by some physiological conditions. Physiological conditions including anemia, active RBC producing state, iron deficiency and hypoxia suppress the hepcidin synthesis. This environment leads to the increased extracellular iron in the body for the iron homeostasis. In contrast, when there is overloaded iron or inflammation, hepcidin expression is increased.

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