Darbepoetin alfa use in trauma and acute care surgery patients who abstain from blood products: A case series and discussion

Purpose: Individuals may abstain from blood products due to religious or cultural beliefs. For trauma victims, blood loss is associated with anemia, decreasing oxygen delivery, and alternative treatment methods to blood transfusion are warranted in this population. Literature has investigated the use of epoetin alfa, an albumin-containing erythropoiesis-stimulating agent (ESA), to treat anemia for this indication; however, this may be problematic as albumin is a blood-derived product. Darbepoetin alfa is an albumin-free ESA alternative. This case series describes the use of darbepoetin alfa on anemia and outcomes in patients who abstain from blood products. Summary: Trauma and acute care surgery patients are at risk for development of anemia related to traumatic injury as well as acute blood loss. Blood product transfusion is a common therapeutic intervention; however, patients may abstain from blood product administration. The 9 patients described herein with anemia (hemoglobin concentration of <7 g/dL or hematocrit level of <21%) during a hospital stay abstained from blood products and received darbepoetin alfa. Initial hemoglobin levels ranged from 4.1 to 10.1 g/dL, and patients received darbepoetin from 1 day to up to 17 consecutive days during their hospital stay. One patient experienced a type II non–ST elevation myocardial infarction. Conclusion: The use of darbepoetin alfa appeared to be a therapeutic option to treat anemia in trauma and acute care surgery patients who abstain from blood products. Future studies are needed to compare epoetin alfa and darbepoetin alfa.