No abstract available.
Anemia* ; Erythropoietin* ; Fetal Blood*

Despite improved perioperative management and surgical techniques, patients undergoing hepatobiliary and pancreatic (HBP) surgery often need to be transfused. Although disadvantages of transfusion and advantages of patient blood management (PBM) have been recognized, study results of the effects of PBM in HBP surgery are rare. The aim of this article was to review the current status of PBM in Korea in patients having HBP surgery. PBM in HBP surgery consists of increasing preoperative hemoglobin level, preoperative blood conservation, and preoperative autologous blood donation. The main intraoperative modalities used to conserve blood in recent studies were autologous techniques of acute normovolemic hemodilution and intraoperative cell salvage (Cell Saver®). In postoperative PBM, blood augmentation with erythropoietin and iron are also used depending on the postoperative hemoglobin level. Advances in surgical, anesthesiologic and pharmacologic strategies have contributed to a reduction of blood loss during HBP surgery in all patients.
Blood Donors ; Erythropoietin ; Hemodilution ; Humans ; Iron ; Korea

OBJECTIVE: To examine the influence of erythropoietin (Epokaine prefil(R)) on transfusion requirements, serum hemoglobin levels in patients with gynecologic malignancies under polychemotherapy and chemotherapy associated anemia. METHODS: From January 2001 to March 2003, 70 patients treated with chemotherapy due to gynecologic cancer from Severance hospital were included into this study. Patients were assigned to one of two groups (case group (n=28) and control group (n=42)). Patients in case group received 2000 U or 6000 U Epokaine(R) subcutaneously two or three times a week for more than 3 cycles (9 weeks), and patients in control group didn't received Epokaine(R) (n=42). If the hemoglobin levels of 1st, 2nd and 3rd cycle >1 g/dL above the baseline value and/or >12 g/dL, patients were classified as responders. Patients who required blood transfusions or if the hemoglobin levels of 1st, 2nd and 3rd cycle <1 g/dL were as non-responders. RESULTS: 28 cases of 70 patients were assessable for response and complication to Epokaine(R) application. In the Epokaine(R) group, 53%, 64%, 71% of the patients responded to the treatment (at 1st, 2nd and 3rd cycle, respectively) and only 7 patients (21.4%) required blood transfusions, whereas 28 patients in control group (66.7%) needed transfusion. Mean transfused units were 1.56 in case group and 3.55 in the control group (P=0.03). In case group, mean hemoglobin levels were significantly increased after the 1st, 2nd and 3rd cycle of chemotherapy (0.73 g/dL, 1.34 g/dL, 1.65 g/dL, respectively) compared with the mean baseline value. CONCLUSION: We concluded that Epokaine(R) significantly decreases transfusions requirements and increases serum hemoglobin levels in patients with gynecological malignancies who are undergoing polychemotherapy. Therefore, Epokaine(R) would be effective in the treatment of anemia of gynecologic cancer patients receiving polychemotherapy.
Anemia* ; Blood Transfusion ; Drug Therapy ; Drug Therapy, Combination ; Erythropoietin* ; Humans*

OBJECTIVETo investigate the expression level of erythropoietin (EPO) and ferritin before and after treatment of patients with iron deficiency anemia (IDA) so as to explore their clinical significance in diagnosis and discrimination.

METHODSThe EPO and ferritin levels in serum of 37 patients with IDA were determined by using chemiluminescence analysis (CLIA method) and electrical chemiluminescence analysis (ECLIA method), 30 healthy people were randomly selected as normal controls.

RESULTS(1) the sEPO level in IDA patients of group before treatment, group treated for 1 month and group treated for 2 months was higher than that in normal control group (P < 0.05). The level of sEPO of IDA patients in different groups after treatment was lower than that in IDA patients of groups before treatment, along with improvement of anemia status, the level of EPO was gradually reduced, and the level of sEPO in patients of group treated for 3 months was not statistical significant in comparison with that in normal control (P > 0.05). The level of ferritin in IDA patients before and after treatment was lower than that in normal control group (P < 0.05). The level of ferritin in IDA patient of groups after treatment was all higher than that in patients of groups before treatment, but comparision of serum ferritin level in patients of groups after treatment did not show statistical significance. (2) The level of logEPO in IDA patient before and after treatment was negatively related with level of Hb, but the level of ferritin in IDA patients was positively related with the level of Hb before treatment (r = 0.449, P = 0.005), the level of ferritin in patients of different group after treatment and in normal group did not related with level of HB. (3) The level of serum EPO in patients of severe anemia group was obviously higher than that in patients of moderate and mild anemia groups, and along with aggravation of anemia, the EPO level was gradually arised.

CONCLUSIONThe serum EPO is involved in the process of erythrocyte hematopoiesis, and can indicate the level of anemia, its sensitivity for anemia is higher than that of ferritin, and has important clinical value for evaluating status of diseases, observing therapeutic efficacy and judging prognosisi of IDA.

Anemia, Iron-Deficiency ; blood ; Case-Control Studies ; Erythropoietin ; blood ; Ferritins ; blood ; Humans

This study was purposed to investigate the role of cytokines in pathogenesis of lymphoma-associated anemia. The levels of IFN-γ, IL-1β, IL-6, TNF-α and EPO in serum from 45 lymphoma patients and 12 normal controls were detected by using ELISA, the EPOR level on bone marrow cells were detected by flow cytometry, the CFU-E of bone marrow cultured in vitro was counted under inverted microscope. The results showed that 25 (55.6%) out of 45 newly diagnosed lymphoma patients had anemia before diagnosis, 13 (28.9%) had anemia during therapy, 7 (15.5%)never had anemia. The IFN-γ and TNF-α levels in serum of patients with moderate and severe anemia were significantly higher than those in patients with mild anemia and without anemia as well as normal controls. The EPO, IL-6 and IFN-γ levels correlated negatively with Hb concentration in patients, the EPOR level in patients without anemia significantly higher than that in patients with anemia and normal controls. The bone marrow CFU-E amount in patients showed positive correlation with Hb and EPOR levels. It is concluded that the increased IFN-γ, TNF-α and IL-6 may contribute to the anemia in lymphoma, and yet the EPO and EPOR levels are elevated to balance negative regulatory effects on hematopoiesis and maintain normal hematopoiesis.
Adult ; Aged ; Anemia ; blood ; etiology ; pathology ; Case-Control Studies ; Cytokines ; blood ; Erythropoietin ; blood ; Female ; Humans ; Interferon-gamma ; blood ; Interleukin-1 ; blood ; Interleukin-6 ; blood ; Lymphoma ; blood ; complications ; pathology ; Male ; Middle Aged ; Receptors, Erythropoietin ; blood ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo study the expression of erythropoietin (EPO) and its receptor (EPOR) in the brain of newborn rats suffering fetal distress.

METHODSA model of fetal distress was prepared by ligating bilateral uterine arteries of the rats with full-term pregnancy for 10 minutes before cesarean sections. The expression levels of EPO and EPOR in the brain of newborn rats were detected by reverse transcription polymerase chain reaction (RT-PCR) and Western blot at 0, 2, 6, 12, 24, 48, 72 hrs and 7 days after birth. Serum EPO levels were measured using ELISA simultaneously. The newborn rats born by cesarean sections which were not subjected to uterine artery ligation were used as the control group.

RESULTSThe expression of EPO protein and mRNA in brain tissues in the fetal distress group increased significantly compared with the control group 2, 6 and 12 hrs after birth (P<0.05). The expression of EPOR protein and mRNA in brain tissues in the fetal distress group increased significantly compared with the control group 2, 6, 12, 24 and 48 hrs, and 3 days after birth (P<0.05). Serum EPO levels in the fetal distress group were significantly higher than in the control group 2 hrs after birth.

CONCLUSIONSThe EPO and EPOR levels in the brain increase quickly after birth in newborn rats suffering from fetal distress. The EPOR is high expressed for a longer time than EPO. This can provide a basis for the treatment of neonatal brain damage induced by fetal distress by exogenous EPO.

Animals ; Animals, Newborn ; Brain ; metabolism ; pathology ; Erythropoietin ; blood ; genetics ; Female ; Fetal Distress ; metabolism ; Pregnancy ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Receptors, Erythropoietin ; blood ; genetics

OBJECTIVETo study the relationship between the levels of erythropoietin (EPO) in serum and brain injury in preterm infants.

METHODSThree hundred and four preterm infants (gestational age: 28-34 weeks) born between October 2014 and September 2015 were enrolled in this study. Brain injury was diagnosed using cerebral ultrasound and MRI. The levels of EPO, S100 protein, neuron-specific enolase (NSE) and myelin basic protein (MBP) in serum were detected using ELISA. To compare the incidence of brain injury in different serum EPO levels in preterm infants, and the relationship between brain injury and serum EPO levels was analyzed.

RESULTSThe incidence rate of brain injury in preterm infants was 41.1% (125/304). The incidence rate of brain injury in the low EPO level group was significantly higher than that in the middle-high EPO level groups (P<0.01). The serum levels of S100 protein, NSE, and MBP in the brain injury groups were significantly higher than in the control group (P<0.01). The serum EPO levels were negatively correlated with serum S100 protein concentration and NSE levels (P<0.05). According to the multiple logistic regression analysis, low gestational age, low birth weight, asphyxia, prolonged mechanical ventilation, anemia and low serum EPO levels were the risk factor for brain injury in preterm infants.

CONCLUSIONSThere is a higher incidence rate of brain injury in preterm infants with lower serum EPO levels. The serum EPO levels may be correlated with brain injury in preterm infants.

Brain Injuries ; blood ; epidemiology ; Erythropoietin ; blood ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; blood ; Male ; Myelin Basic Protein ; blood

BACKGROUND: We established a bloodless center at Soonchunhyang University Hospital (SCH) in 1996 and have provided medical and surgical care for Jehovah's Witness patients. In this study, we evaluated their outcomes to provide the basis of bloodless medicine and surgery in Korea. METHODS: A retropective review of the medical records of 757 Jehovah's Witness patients admitted in the SCH Bloodless Center from December 1996 to July 2003 was performed. RESULTS: Among 757 patients, 19 (2.5%) expired during treatment and 4 of them died of cardiopul-monary dysfunction secondary to anemia. As alternatives to blood transfusion, 85 (11.2%) patients were treated with iron, 81 (10.7%) with erythropoietin, 49 (6.5%) with aprotinin, 31 (4.1%) with hemodilution and 28 (3.7%) with cell saver. Four hundreds fifteen (54.8%) of 757 patients underwent surgery. The most frequently involved cinical department was Obstetric/Gynecology (23.8%). The ratio of female and the percentage of cases treated with alternatives to blood transfusion were higher in surgery group than non-surgery group patients.(Chi-square test, P<0.01) CONCLUSIONS: Most Jehovah's Witness patients were treated successfully in our bloodless center with various alternatives to blood transfusion, such as erythropoietin, intraoperative autotransfusion, acute normovolemic hemodilution etc. Collaboration and good communication among surgeons, anesthesiologists, hematologists and blood bank physicians are very important to provide qualified medical or surgical treatment to the patients who have a religious objection to receiving blood or blood-related products.
Anemia ; Aprotinin ; Blood Banks ; Blood Transfusion ; Blood Transfusion, Autologous ; Cooperative Behavior ; Erythropoietin ; Female ; Hemodilution ; Humans ; Iron ; Korea ; Medical Records

PURPOSE: In this study, we administered erythropoietin preoperatively to patients who underwent open radical prostatectomy without transfusion to increase their hemoglobin levels and investigated the efficacy of this procedure. MATERIALS AND METHODS: We evaluated 62 patients who underwent open radical prostatectomy performed by the same surgeon between June 2005 and January 2011. The 22 patients who refused transfusion were assigned to group 1; the patients who accepted transfusion were assigned to group 2. Before surgery, we administered erythropoietin beta to group 1 patients whose hemoglobin levels were <12 g/dL and retrospectively compared the clinical data of the two groups. We used the t-test and the chi-square test for statistical analysis. RESULTS: Mean preoperative hemoglobin levels in group 1 after erythropoietin administration (14.5 g/dL) were significantly higher than those in group 2 (13.59 g/dL, p=0.003). Moreover, the difference in the mean hemoglobin levels before and after surgery for group 1 patients (3.55 g/dL) significantly exceeded that for group 2 patients (2.08 g/dL, p=0.000). Additional analysis revealed no statistically significant differences in perioperative complications between the groups. CONCLUSIONS: Preoperative erythropoietin administration increased the safety margin of hemoglobin levels, and this strategy worked sufficiently well in our experience.
Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Erythropoietin* ; Humans ; Jehovah's Witnesses ; Prostate* ; Prostatectomy* ; Prostatic Neoplasms* ; Retrospective Studies

STUDY DESIGN: Prospective randomized clinical trial. OBJECTIVES: To determine the minimal effective pretreatment dosage of recombinant human erythropoietin for preoperative autologous donation in lumbar stenosis surgery. SUMMARY OF LITERATURE REVIEW: Preoperative autologous donation is one of the most widely used methods of autotransfusion. However securing predetermined amount may be difficult due to falling hematocrit with repeated donation especially in patients with low basal hematocrit. In this situation recombinant human erythropoietin(Epoetin alfa) may be used. MATERIALS AND METHODS: Forty five lumbar stenosis patients requiring posterior wide decompression and posterolateral fusion with instrumentation, who had basal hematocrit less than 40% were selected and alloted randomly into 3 groups. Group I(n=15) had pretreatment with Epoetin alfa 50 unit/kg. Group II(n=15) was pretreated with 25 unit/kg. Group III(n=15) had no pretreament. Patients were excluded from donation when their hematocrit values were less than 33%. RESULTS: The mean number of units collected per patient(mean+/-SD) was 3 for group I(P<0.05), 2.84 for group II and 2.67 for the control group. The red cell volumes in pretreated groups(347 ml, 325 ml) were greater than in group III(255 ml, P<0.05). The differences between hematocrits of the first and the third preoperative donations were significantly less in group I(1.50) and group II(1.51) than that of control group(3.73). Two patients in group II and 3 patients in group III required additional homologous transfusion postoperatively. And there were no significant differences in the pattern of postoperative changes of hemoglobin among the groups. There were no significant differences in amount of intraoperative saved blood, postoperative reinfused blood, and postoperative drainage. CONCLUSION: Fifty units/kg of Epoetin alfa seems to be more effective than twenty-five units/kg for preoperative autologous donation in patients requiring posterior wide decompression, posterolateral fusion with instrumentation.
Blood Transfusion, Autologous ; Cell Size ; Constriction, Pathologic* ; Decompression ; Drainage ; Erythropoietin* ; Hematocrit ; Humans* ; Prospective Studies ; Epoetin Alfa