REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
This article is part of the Research TopicPerioperative Blood Transfusion Management in the Perioperative SettingView all articles
Effects of Erythropoietin Administration on Allogeneic Blood Transfusion Requirements in Adults Undergoing Surgery: A Systematic Review and Meta-Analysis
Provisionally accepted
- Chongqing Jiangjin Second People's Hospital, Chong'qing, China
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Background Erythropoietin is commonly integrated into blood management strategies for surgical patients, yet its administration may lead to adverse outcomes. This systematic review and meta-analysis assesses the impact of erythropoietin administration on perioperative transfusion requirements and adverse events. Methods A comprehensive search across four databases was conducted from inception to 30 July 2025 to identify randomized controlled trials involving adult surgical patients. The methodological quality of the included studies was evaluated using the Cochrane Risk of Bias Assessment Tool. The outcome measures included transfusion rates, volume of allogeneic red blood cell transfusions per patient unit, mortality rates, postoperative infection rates, transfusion-related complications, venous thromboembolism rates, and length of hospital stay. Effect sizes were reported using Relative Risk (RR) and Standardized Mean Difference (SMD). We used GRADE to assess the quality of evidence for each outcome. Results Preoperative erythropoietin administration reduces transfusion rates (RR=0.63, 95% CI=0.53–0.75, p=0.000) and mean transfusion volumes (SMD=−0.33, 95% CI=−0.42 to −0.24, p=.000) in surgical patients. No significant impact was observed on mortality, postoperative infection incidence, postoperative complications, adverse reactions, venous thromboembolic events, and length of hospital stay. Subgroup analyses showed significant reductions in transfusion rates for cardiac surgery, orthopedic surgery, gastrointestinal surgery, gynecological abdominal surgery, and other types of surgery. Conclusion The available evidence supports the efficacy of preoperative human erythropoietin administration in reducing transfusion requirements and the average number of transfusion units in adult surgical patients. No significant differences were observed in postoperative mortality, complication rate, adverse event rate, venous thromboembolic events (including deep vein thrombosis and pulmonary embolism), and hospital stay after preoperative administration of erythropoietin.
Keywords: Erythropoietin, Surgical Procedures, Blood Transfusion, Adult, randomized controlled trial
Received: 24 Sep 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 Chen, Liu, Cao, Tian and He. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jie He
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