To the Editor: Dr Corwin and colleagues1 reported that recombinant human erythropoietin (rHuEPO) resulted in a 10% absolute reduction in number of critically ill patients who underwent transfusion with red blood cells (RBCs) and in a 19% relative reduction in the units of RBCs transfused. Most of these patients, however, were not anemic, with mean baseline hemoglobin levels of 9.97 g/dL and mean pretransfusion levels of approximately 8.50 g/dL. Nonetheless, 21% of patients received RBC transfusions for hemoglobin levels greater than 9 g/dL. In the absence of myocardial ischemia or recognized blood loss, these treatment decisions would appear to contradict the evidence of the lack of significant benefit and trends toward harm demonstrated with intervention to maintain hemoglobin levels of 9 g/dL.2 Indeed, subgroup analysis of RBC transfusion requirements demonstrated no significant difference between the groups when baseline hemoglobin levels were less than 9 g/dL.
We also are concerned about the cost of rHuEPO. Based on cost estimates in the article, the cost for rHuEPO per patient receiving 2 to 3 doses of 40 000 units is in the range of $800 to $1200. Given the small absolute reduction in patients who underwent rHuEPO transfusion, however, the cost of rHuEPO probably far exceeds the savings from avoiding transfusion of an equivalent number of units of RBCs. Thus, it is not clear whether rHuEPO is a cost-effective therapy in this setting. Other strategies to reduce the use of allogenic RBC transfusion with rHuEPO have failed to show cost benefit.3 Although the study by Corwin et al did not have sufficient power to assess mortality or adverse events, it should be emphasized that no difference was observed between groups for these end points.
With greater understanding of the physiology of human erythropoietin, there may be indications for rHuEPO therapy in critically ill patients.4 - 6 Therefore, recent concern regarding the potentially serious and underreported incidence of red-cell aplasia associated with rHuEPO therapy should be further characterized with long-term studies in patients receiving rHuEPOtherapy.7
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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