I was told that EPO was of no use in emergency surgery as it took too long for it to have any effect on the patient.
Does anyone have any experience of this and can anyone tell me how long EPO takes to start working when it is given in an emergency situation (non-elective surgery). Does it start to work on an incremental basis or is there a sudden "kick"? What is the timeline for this?
Any input would be appreciated.
Nanuke wrote:
epo / timing
In regard to epo / timing / and emergency use. The answer isn't as easy as you would like. My usual explanation is this. If this is acute blood loss issue, e.g. GI Bleed or hemorrhage; not the epo won't do anything until you refill the iron tank (my expression). I am not sure what Sodium Ferric Gluconate is marketed under in the UK but we are restricted her in the US in regard to its dosing. Once it is available to administer in an easier format it would be the drug of choice. The fastest we have been able to administer it is 125mg / daily times or equal to a total of 1gm. For example; If you witnessed or know that the patients acute blood loss was 1 liter, there is no reason to even check Iron Saturation levels (need to have a minimum of 20% for rhEpo to even work in a semi reasonable time frame). That patient will have to have a total of 1 gm and at the 500 mg mark would be a guess as to whether he is ready for epo or not. Here is the point. If you have a center that does epo levels in less than 3 days like our, (and there is much debate in the literature about this) and you know they are in otherwise general good health (meaning no cardiac, oncology, or nephrology issue) and they have a level of 190 or higher epo level===they DO NOT NEED rhEpo. They NEED IRON. The only IV iron in the US that can do a one time load dose is Infed (Iron Dextran). If the patient is premedicated with Diphenhydromine and or Solu-medrol the allergic reaction potential drops significantly. I apologize....as Jan can tell you I tend to talk far too much about this and love it.....feel free to send me an email anytime in regard to this subject.
Trudi Gallagher RN.

Would anyone like to add to this please? In particular I would like to know whether EPO is of any use in an emergency situation when the patient has refused blood products.
Details:
Road Traffic Accident victim. Male 17yrs. Height 5'10". Weight 140lbs. Closed fractures to femur, tibia and fibula of R leg. No other injuries. Usual blood tests done on admission. Hb 14.0. All other tests within accepted parameters.
Refused blood (JW). No other health problems.
Crash happened 8pm. Admitted to A&E at 9pm. Approx Blood loss estimated as 2litres by 11pm. Operated on to reduce fractures 00:15am. (By which time Hb was 2.0) Treatment before op: 7litres fluids IV. Died 06.30 (Severe dilutional anaemia).
My question is: would EPO or Iron dextran (or anything else) have been of any use?
I am not in the medical profession so laymans terms would be appreciated.
The patient was my son.