Heiss M M, Tarabichi A, Delanoff C, Allgayer H, Jauch K W, Hernandez-Richter T, Mempel W, Beck K G, Schildberg F W, Messmer K
Department of Surgery, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany.
Surgery. 1996 May;119(5):523-7. doi: 10.1016/s0039-6060(96)80261-3.
Blood transfusions are associated with higher postoperative morbidity and tumor recurrence rates in colorectal cancer surgery, To reduce the need for transfusions in patients with tumor-induced anemia who are not suitable for autologous blood donation, it was tested whether perisurgical erythropoietin application would be able to stimulate hematopoiesis adequately.
In a double-blind randomized study 150 IU/kg body weight erythropoietin was given subcutaneously every 2 days beginning 10 days before operation and continuing until postoperative day 2. Twenty patients were randomized into the erythropoietin group with three observed dropouts and 10 patients into the placebo group.
In the erythropoietin group two episodes of hypertension and one deep venous thrombosis were observed. Preoperative hemoglobin response in the erythropoietin group (p = 0.069) was paralleled by a highly significant reticulocyte increase (p = 0.0004). However, frequency of blood transfusion was not different between both study groups (erythropoietin, 1.82 +/- 0.80 units/ patient; placebo, 1.80 +/- 0.97 units/patient). If iron availability was analyzed, a strong correlation between ferritin blood levels and transferrin iron saturation with hemoglobin response was observed in regression analysis (p < 0.001).
These results indicate that hematopoiesis in anemic patients with colorectal cancer can be stimulated by erythropoietin; however, clinical efficacy is to be expected only in selected patients with high iron availability, which calls for further studies combining erythropoietin and parenteral iron application.
在结直肠癌手术中，输血与更高的术后发病率和肿瘤复发率相关。为了减少不适合自体献血的肿瘤性贫血患者的输血需求，测试了围手术期应用促红细胞生成素是否能够充分刺激造血功能。
在一项双盲随机研究中，从术前10天开始，每2天皮下注射150IU/kg体重的促红细胞生成素，持续至术后第2天。20例患者被随机分为促红细胞生成素组，3例观察到退出研究；10例患者被分为安慰剂组。
在促红细胞生成素组中，观察到2例高血压发作和1例深静脉血栓形成。促红细胞生成素组术前血红蛋白反应（p = 0.069）伴随着网织红细胞显著增加（p = 0.0004）。然而，两个研究组之间的输血频率没有差异（促红细胞生成素组，1.82±0.80单位/患者；安慰剂组，1.80±0.97单位/患者）。如果分析铁的可利用性，回归分析显示铁蛋白血水平和转铁蛋白铁饱和度与血红蛋白反应之间存在强相关性（p < 0.001）。
这些结果表明，促红细胞生成素可以刺激结直肠癌贫血患者的造血功能；然而，仅在铁可利用性高的特定患者中预期有临床疗效，这需要进一步研究促红细胞生成素与胃肠外补铁联合应用。
