Is the intractable anemia due to renal insufficiency? Why is EPO not effective? Is patient receiving oral or IV iron? He/she might be in a stage of functional iron deficiency which occurs when EPO stimulates bone marrow but iron, an ingredient in blood formation is deficient.

Hb of 7 or 8 gms is very low for someone to undergo CABG. Could the renal problem (if there is) be corrected or ameliorated preop?

Perhaps, consultation with specialists in Transfusion-free Centers, especially those where cardiac surgery is done, would be a better option.

Regards,

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Angelina A. Gapay, MD