NoBlood

I would like to add to the excellent comments from Trudi. ER situations are difficult as it is true, EPO/FE take time to work. Factors such as the age of the patient, amount of on-going blood loss, surgical intervention, amount of lab sampling and how many other blood conservation measures are being utilized all effect a patient's anemic status. However, keep in mind that using EPO is not just 'prevention'. Using it in any anemic situation can make the difference between giving 2 units of blood as opposed to 10 units (if the patient is willing to receive blood products). At St. Vincent Charity Hospital we have documented many case studies in which erythropoiesis was evident in 48-72 hours after admistering EPO/FE. Disregarding the value of the use of this drug in an ER situation may set you up for failure down the road, due to many unknowns. And, you may have delayed valuable erythropoietic action. Also, keep in mind that any potential ER sepsis situation ( gunshot wound, compound fx, rupture diverticuli, etc) may preclude the use of iron, but not EPO. Our rule of thumb in ER situations is to use the complete tool box of conservation techniques, that are available, as early as possible.
I would appreciate the comments of others.