Rapid restoration of red blood cell mass in severely anemic surgical patients who refuse transfusion
S. J. Dudrick, J. J. O'Donnell, D. P. Raleigh, R. G. Matheny and S. P. Unkel
Optimal parenteral nutritional support, concomitant with replacement doses
of intravenous iron dextran injection, can be safe, effective, and
lifesaving for severely anemic patients who are unable to receive blood
transfusions. Six patients who had sustained massive acute blood loss and
two who had severe chronic anemia received as much as 140 mL of iron
dextran injection intravenously. The average initial hemoglobin level in
the acute group was 5.0 g/dL (range, 2.6 to 8.4 g/dL) and increased to an
average of 10.6 g/dL (range, 7.5 to 12.8 g/dL) in 23 days (range, 17 to 30
days); the hemoglobin level in the chronic group was 3.8 g/dL and increased
to 10.6 g/dL over an average period of 121 days. Two total abdominal
colectomies, a right transverse colectomy and fistulectomy, a pyloroplasty
and vagotomy, and a highly selective vagotomy were accomplished without
complications in five of the patients. There were no adverse reactions to
the hematopoietic therapy.
