Iron alone or iron and erythropoietin added to acute normovolemic hemodilution in myomectomy patients: A randomized controlled trial

Purpose
The purpose was to study the effect of recombinant human erythropoietin (rHuEPO) and iron or iron alone with acute normovolemic hemodilution (ANH) on blood transfusion requirements in elective myomectomy patients.
Methods
Ninety female patients scheduled for myomectomy and ANH after induction of general anesthesia were randomly allocated into three equal groups (30 patients each); Group I (control group): Patients scheduled for ANH alone; Group II: Patients received oral ferrous iron sulfate 320 mg tablets twice daily for 2 weeks before surgery; and Group III: Patients received oral ferrous iron sulfate 320 mg tablets twice daily and recombinant human erythropoietin (rHuEPO) in a dose of 100 IU/kg subcutaneously twice a week for 2 weeks before surgery.
Results
There was a significant increase in Hb (g/dL) and Hct % ( < 0.0001) in groups II and III compared to group I, and in group III compared to group II at all the predetermined times. There was a significant increase in blood volume that can be removed by ANH (ml) in groups II (1250 ± 280) and III (1986.7 ± 292.8) compared to group I (987. 4 ± 176.6), and in group III compared to group II ( < 0.001). The median number of blood units removed by ANH was significantly increased in group III {3 (1–3)} compared to groups I and II {2 (1–3)} ( < 0.001). The number of patients who received homologous blood transfusion was decreased in group III [1 (3.33%)] compared to the two other groups, and in group II [5 (16.7%)] compared to group I [10 (33.3%)].
Conclusion
Preoperative iron alone or iron and erythropoietin added to acute normovolemic hemodilution help to reduce the need for allogenic blood transfusion in myomectomy patients. Further studies are needed to evaluate their use in older patients with higher risk for thrombosis and hypertension.