Recombinant human erythropoietin therapy in critically ill patients

Objective

The aim of our study was to assess the efficacy of two dosing schedules of recombinant human erythropoietin (rHuEPO) in increasing hemoglobin (Hb) level and reducing the exposure to allogeneic red blood cells (RBC) transfusion in critically ill patients.

Design

A prospective, randomized, multicenter trial.

Settings

A total of 13 intensive care units participated in the study.

Patients

A total of 148 patients who met eligibility criteria were enrolled.

Intervention

Patients were randomly assigned to receive intravenous (i.v.) iron saccharate alone (control group), i.v. iron saccharate and subcutaneous rHuEPO 40,000 units once per week (group A) and i.v. iron saccharate and subcutaneous rHuEPO 40,000 units three times per week (group B). rHuEPO was given for a minimum of 2 weeks or until ICU discharge or death. The maximum duration of therapy was 3 weeks.

Results

The cumulative number of RBC units transfused, the average RBC units transfused per patient and per transfused patient, the average volume of RBC transfused per day and the percent of transfused patients were significantly higher in the control group than those in groups A and B. No significant difference was observed between group A and group B. The mean increase in hematocrit (ΔHct) and Hb (ΔHb) from baseline to final measurement were significantly higher in group B than those in control group. ΔHct was significantly higher in group B than that in group A. ΔHct in group A was significantly higher than that in controls, whereas ΔHb did not differ significantly between the control group and group A.

Conclusion

Administration of rHuEPO in critically ill patients significantly reduced the need for RBC transfusions. The magnitude of the reduction did not differ between the low and high doses of rHuEPO, whereas there was a dose response of Hct and Hb to rHuEPO in these patients.