Dartmouth-hitchcock researchers find hormone decreases need for blood transfusions

Results of a 2 ½ year study led by doctors at Dartmouth-Hitchcock Medical Center could have implications for the nation’s decreasing blood supply.

In an article published in the December 11 issue of the Journal of the American Medical Association (JAMA), Drs. Howard L Corwin and Andrew Gettinger describe the effects of administering recombinant human erythropoietin (rHuEPO) to critically ill patients. Significantly, they found that use of the hormone, which stimulates red blood cell production, resulted in a 19 percent reduction in red blood cell transfusion to those patients.

The double-blind, placebo-controlled trial was conducted at 65 centers between December 1998 and June 2001. 1,302 patients who had been in the Intensive Care Unit (ICU) for two days and were expected to be in ICU for at least two more days, were enrolled. Patients were randomly assigned to receive either 40,000 units of rHuEPO or placebo on day three in the ICU. These doses then continued weekly.

The study found that patients who received rHuEPO were less likely to need a transfusion of red blood cells and showed a greater increase in hemoglobin. “Weekly therapy with 40,000 units of rHuEPO in critically ill patients results in a significant reduction in their exposure to … RBC tranfusions,” the authors wrote.

Current estimates are that 35-50 percent of all patients admitted to ICU’s in the U.S. and Western Europe receive almost 5 RBC units during their ICU stay. Concern about infection and suppression of the immune system as a result of transfusions have led doctors to seek alternatives that would reduce these risks, while not neglecting the anemia that is common in ICU patients.

“The view of RBC transfusion as risk-free is no longer tenable,” the authors note. “Adding to the controversy about risk-benefit ratio for RBC transfusion are recent data showing that an aggressive RBC transfusion strategy may decrease the likelihood of survival in selected subgroups of critically ill adults.”

Reducing reliance on blood transfusions could have many benefits, according to the authors: “Not transfusing “unnecessary” units of RBC avoids the morbidity and mortality directly associated with each RBC unit transfused, as well as the potential for medical errors associated with the transfusion process itself.” And, referring to the state of the nation’s blood supply, they write, “The avoidance of unnecessary blood transfusions would also save a resource that is becoming increasingly scarce.”

While further study is needed to assess the cost-effectiveness of the therapy, as well as its effects on clinical outcomes, Dr. Gettinger is encouraged that initial findings may lead to improved results for critically-ill patients, and lessen reliance on blood transfusion generally: “The standard of care in manging the anemia in critically ill patients has always been to tranfuse allogeneic blood,” he said. “As risks of allogeneic blood are better understood, the opportunity to treat anemia with a non-blood product alternative and decrease the dependence on an increasingly scarce resource is significant.”

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Dartmouth-Hitchcock Medical Center (DHMC) is an integrated academic medical center located on a 225-acre campus in the heart of New Hampshire’s Upper Connecticut River Valley in Lebanon. DHMC comprises Mary Hitchcock Memorial Hospital (a 396-bed tertiary care hospital), the Dartmouth-Hitchcock Clinic (a network of more than 900 primary and specialty care physicians located throughout New Hampshire and Vermont), Dartmouth Medical School and the Veteran’s Affairs Medical Center Memorial Hospital in White River Junction, VT.