Iron Alone or Iron and Erythropoietin Added to Acute Normovolemic Hemodilution in myomectomy patients : A Randomized controlled Trial

Patients were randomly allocated into three equal groups (30 patients each). Group I (control group): Patients scheduled for acute normo-volemic hemodilution (ANH) alone after induction of general anesthesia. Group II: Patients received oral ferrous iron sulfate 320 mg tablets twice daily for 2 weeks before surgery and scheduled for ANH after induction of general anesthesia. 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 and scheduled for ANH after induction of general anesthesia. The ANH was started just after tracheal intubation through the internal jugular vein. The volume to be withdrawn was calculated (maximum 3 unites), while maintaining the Hct level more than 28%. The first 1000 cc of blood withdrawn was replaced with equal volume of hydroxyl-ethyl starch 6%, then any additional blood was replaced with crystalloid solution in the ratio of 3:1. The volume of blood that could be withdrawn during ANH from each patient was calculated using the following formula: V = EBV × (Hi – Hf )/ Hav V = Volume of blood that could be removed EBV = Estimated blood volume Hi = initial hematocrite level Hf = the target hematocrite level following ANH Hav = the average hematocrite level of Hi and Hf. The number of blood units withdrawn by ANH was recorded. The volume of blood loss was estimated by estimation of blood in the surgical sponges (5 = mildly, 10 =moderately, and 15 = severely soaked) and pads (50 = mildly, 100 = moderately, and 150 = severely soaked) and, observing the volume of blood in the suction apparatus and the surgical drains. Blood transfusion was given if Hb level was < 8 g/dl and, if there was abnormal ECG, ischemic heart disease or obstructive lung disease and the Hb level was 8-10 g/dl. No transfusion was given if Hb level was more than 10 g/dl. If the patient was in-need for blood transfusion, the blood removed by ANH was given first, starting with the last unit collected then, homologous blood. At the end of surgery all autologous blood was returned to the patient. The first 1000 cc of blood withdrawn by ANH were replaced with equal volume of 6% hydroxyethyl starch. Subsequent blood withdrawn was replaced with ringer’s solution at a ratio of 3 :1. All patients were pre-medicated with 0.01 mg/kg midazolam intravenous before induction of anesthesia and monitored for ECG, oxygen saturation, capnography and non-invasive blood pressure. A urinary catheter was inserted for collection of urine output.