***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Patients having a cardiac operation frequently require allogeneic blood transfusions despite surgical blood-conservation techniques . Recombinant human erythropoietin ( Epoetin alfa ) may augment this conservation by stimulating erythropoiesis . The safety and efficacy of perioperative use of Epoetin alfa to reduce the need of allogeneic transfusion was studied . METHODS A multicenter double-blind , placebo-controlled , parallel-group study involved 182 patients having coronary artery bypass grafting and r and omized to receive Epoetin alfa  ( 300 or 150 IU/kg ) or placebo subcutaneously for 5 days before , on the day of , and for 2 days after operation . RESULTS Perioperative Epoetin alfa result ed in greater increases in baseline to preoperative hemoglobin levels and hematocrit ( 300 IU/kg ) and in presurgery to postsurgical day 1 reticulocyte counts versus placebo ( p < or = 0.05 ) . However , there was no significant difference in transfusion requirements . Incidences of adverse events were similar in all study groups . CONCLUSIONS Lower incidences of allogeneic blood exposure were observed in both Epoetin alfa-treated groups ; however , the differences between all treatment groups were not significant . This was probably due to the relatively short 5-day preoperative course of Epoetin alfa therapy . There were no significant differences between the three groups relative to safety .  Epoetin alfa was well tolerated in this population CONTEXT Anemia is common in critically ill patients and results in a large number of red blood cell ( RBC ) transfusions . Recent data have raised the concern that RBC transfusions may be associated with worse clinical outcomes in some patients . OBJECTIVE To assess the efficacy in critically ill patients of a weekly dosing schedule of recombinant human erythropoietin ( rHuEPO ) to decrease the occurrence of RBC transfusion . DESIGN A prospect i ve , r and omized , double-blind , placebo-controlled , multicenter trial conducted between December 1998 and June 2001 . SETTING A medical , surgical , or a medical/surgical intensive care unit ( ICU ) in each of 65 participating institutions in the United States . PATIENTS A total of 1302 patients who had been in the ICU for 2 days and were expected to be in the ICU at least 2 more days and who met eligibility criteria were enrolled in the study ; 650 patients were r and omized to rHuEPO and 652 to placebo .  INTERVENTION Study drug ( 40 000 units of rHuEPO ) or placebo was administered by subcutaneous injection on ICU day 3 and continued weekly for patients who remained in the hospital , for a total of 3 doses . Patients in the ICU on study day 21 received a fourth dose . MAIN OUTCOME MEASURES The primary efficacy end point was transfusion independence , assessed by comparing the percentage of patients in each treatment group who received any RBC transfusion between study days 1 and 28 . Secondary efficacy end points identified prospect ively included cumulative RBC units transfused per patient through study day 28 ; cumulative mortality through study day 28 ; change in hemoglobin from baseline ; and time to first transfusion or death . RESULTS Patients receiving rHuEPO were less likely to undergo transfusion ( 60.4 % placebo vs 50.5 % rHuEPO ; P<.001 ; odds ratio , 0.67 ; 95 % confidence interval [ CI ] , 0.54 - 0.83 ) . There was a 19 % reduction in the total units of RBCs transfused in the rHuEPO group ( 1963 units for placebo vs 1590 units for rHuEPO ) and reduction in RBC units transfused per day alive ( ratio of transfusion rates , 0.81 ; 95 % CI , 0.79 - 0.83 ; P = .04 ) . Increase in hemoglobin from baseline to study end was greater in the rHuEPO group ( mean [ SD ] , 1.32 [ 2 ] g/dL vs 0.94 [ 1.9 ] g/dL ; P<.001 ) . Mortality ( 14 % for rHuEPO and 15 % for placebo ) and adverse clinical events were not significantly different . CONCLUSIONS In critically ill patients , weekly administration of 40 000 units of rHuEPO reduces allogeneic RBC transfusion and increases hemoglobin . Further study is needed to determine whether this reduction in RBC transfusion results in improved clinical outcomes The importance and variability of pre‐operative anaemia in cardiac surgical patients across the UK is not known , and there is debate about its association with patient outcomes . The Association of Cardiothoracic Anaesthetists carried out its first national audit on anaemia and transfusion , and analysed data from 19,033 patients operated on in 12 cardiac surgical centres between 2010 and 2012 ; 5895 ( 31 % ) had pre‐operative anaemia . Centre‐specific prevalence of anaemia varied from 23 % to 45 % ; anaemia was associated with older patients , diabetes and surgical risk ( EuroSCORE ) . Nevertheless , controlling for these factors , regional variation remained an independent effect ( p < 0.001 ) . Multivariable analysis demonstrated an independent association of anaemia with transfusion ( odds ratio ( 95 % confidence interval ) 2.75 ( 2.55–2.95 ) , p < 0.001 ) , mortality ( 1.42 ( 1.18–1.71 ) , p < 0.001 ) and hospital stay ( geometric mean ratio ( 95 % confidence interval ) 1.15 ( 1.13–1.17 ) , p < 0.001 ) . Haemoglobin concentration per se was also independently associated with worse outcomes ; a 10 g.l−1 decrease in haemoglobin was associated with a 43 % increase ( 95 % confidence interval 40–46 % ) in the odds of transfusion and a 16 % increase ( 95 % confidence interval 10–22 % ) in the odds of mortality ( both p < 0.001 ) . This large UK‐wide audit has demonstrated marked regional variation in both anaemia and transfusion , with a consistently high incidence of both . The independent association between pre‐operative anaemia and worse outcomes in UK practice has also been confirmed , and robust prospect i ve study of anaemia treatment before cardiac surgery is required ; these data will assist in design ing such trials BACKGROUND The increasing incidence of osteoporotic hip fracture ( HF ) has raised the requirements of red blood cell ( RBC ) transfusions , whereas this scarce re source may cause morbidity and mortality . STUDY DESIGN AND METHODS This study was a multicenter , r and omized , double-blind , clinical trial that aim ed to assess efficacy of ferric carboxymaltose ( FCM ) with or without erythropoietin ( EPO ) in reducing RBC transfusion in the perioperative period of HF . Participants ( patients > 65 years admitted with HF and hemoglobin [ Hb ] levels of 90 - 120 g/L ) were r and omly assigned to receive a preoperative single dose of 1 g of FCM ( short intravenous [ IV ] infusion over 15 min ) , plus 40,000 IU of subcutaneous EPO ( EPOFE arm ) ; versus 1 g of IV FCM plus subcutaneous placebo ( FE arm ) ; and versus IV and subcutaneous placebo ( placebo arm ) . Primary endpoint was the percentage of patients who received RBC transfusion , and secondary endpoints were the number of RBC transfusions per patient , survival , hemoglobinemia , and health-related quality of life ( HRQoL ; by means of Short Form 36 Version 2 question naire ) . RESULTS A total of 306 patients ( 85 % women , mean age 83 ± 6.5 years ) were included . A total of 52 , 51.5 , and 54 % of patients required RBC transfusion in the EPOFE , FE , and placebo arms , respectively , with no significant differences in the number of RBC transfusions per patient , survival , HRQoL , and adverse events among treatment groups . A significant increase in Hb levels was achieved at discharge ( 102 g/L vs. 97 g/L ) and 60 days after discharge ( 125 g/L vs. 119 g/L ) in the EPOFE arm with respect to placebo arm ; in addition , a higher rate of patients recovered from anemia in the EPOFE arm with respect to the placebo arm ( 52 % vs. 39 % ) , 60 days after discharge . CONCLUSION Preoperative treatment with FCM alone or in combination with EPO improved recovery from postoperative anemia , but did not reduce the needs of RBC transfusion in patients with HF AIMS The aim of this study was to evaluate , in anaemic patients , the efficacy of erythropoietin ( EPO ) in reducing red cell ( RC ) transfusion rates post TAVI . METHODS AND RESULTS This was a r and omised double-blind trial . Patients with severe symptomatic aortic stenosis and concomitant anaemia with an indication for TAVI were r and omised ( 1:1 ) to receive two weight-based doses of EPO ( darbepoetin alfa)+iron or placebo at days 10 ( ±4 days ) and 1 ( ±1 day ) pre TAVI . The primary outcome was the rate of RC transfusions at 30 days . A total of 100 patients ( mean age 81±7 years , male 49 % ) were included : 48 patients received EPO ( + iron ) and 52 patients  received placebo . Baseline characteristics and procedural findings were well balanced between groups except for baseline haemoglobin levels , which were lower in those patients receiving EPO ( 10.7±1.2 vs. 11.3±1.1 g/dl , p=0.01 ) . The rate of 30-day RC transfusion was similar in both groups ( 27.1 vs. 25.0 % in the EPO and placebo groups , respectively ; adjusted odds ratio 1.05 , 95 % CI : 0.42 - 2.64 , p=0.92 ) , and no differences were observed in the number of RC units per transfused patient ( 1 [ 1 - 3 ] vs. 2 [ 1 - 2 ] in the EPO and placebo groups , respectively , adjusted p=0.99 ) . Rates of 30-day mortality , stroke , new-onset atrial fibrillation , acute kidney injury , and troponin peak were also similar between groups ( p>0.20 for all ) . CONCLUSIONS EPO ( + iron ) administration failed to reduce RC transfusion rates or the per-patient number of transfusion units in anaemic patients undergoing TAVI Total hip joint arthroplasty is frequently associated with transfusion of allogeneic blood ( 1 , 2 ) . Although serologic screening has reduced the risk for viral infection to a low level ( 3 , 4 ) , the public is highly concerned about this potential complication of transfusion ( 5 ) . Therefore , further refinement of strategies to avoid exposure to allogeneic blood is needed . The most commonly used preventive strategy is autologous blood donation ( 6 ) . Blood is collected from the patient before surgery and is reinfused if transfusion is necessary . In the past decade , this maneuver , which reduces exposure to pathogens and red cell alloimmunization , has become a st and ard of care in orthopedic surgery ( 7 , 8) . However , autologous blood donation has several disadvantages . First , donation and banking of autologous blood are inconvenient to patients ( 9 , 10 ) . Second , phlebotomy increases the prevalence of postoperative anemia and transfusion ( either autologous or allogeneic ) ( 11 ) . Third , use of autologous blood is not without risk ( 12 , 13 ) . Bacterial contamination of predonated blood ( 14 ) and major transfusion reactions ( due to administrative error ) ( 15 ) are rare but may be life-threatening . Finally and most important , many patients are not eligible for predonation because of concomitant medical conditions ( 16 ) . Erythropoietin , a glycoprotein produced by the kidney , stimulates production of red blood cells from the bone marrow ( 17 ) . Administration of recombinant human erythropoietin ( epoetin alfa ) reduces the risk for allogeneic blood transfusion in patients undergoing total hip joint arthroplasty ( 18 , 19 ) . Factors that influence the response to epoetin alfa include the dose and timing of treatment ( 20 ) , coadministration of iron ( 21 , 22 ) , and baseline hemoglobin concentration ( 23 ) . Although several different preoperative regimens have been described , the regimen approved by the U.S. Food and Drug Administration consists of four subcutaneous injections of epoetin alfa , 600 U/kg of body weight , administered before surgery ( weeks 3 , 2 , and 1 and the day of surgery ) ( 24 ) . Thus , a person weighing 70 kg would require a total dose of 168 000 U. On the basis of subgroup analysis from a previous study ( 18 ) , we hypothesized that a 
    Output:
    
Conclusion Administration of ESA and iron therapy reduced the risk for RBC transfusion compared with iron therapy alone in patients undergoing cardiac and non-cardiac surgery .
Although the analysis was probably under-powered for some outcomes , no difference in the incidence of serious adverse events was observed with ESA and iron compared with iron alone .
Further large prospect i ve trials are required to confirm these findings .RésuméObjectifL’anémie ferriprive est prévalente chez les patients chirurgicaux et est associée à un risque accru de transfusion de culots sanguins allogènes et d’événements indésirables .
Conclusion L’administration d’un traitement d’ASE et de fer a réduit le risque de transfusion de culots sanguins par rapport à un traitement à base de fer uniquement chez les patients subissant une chirurgie cardiaque ou non cardiaque .
Bien que notre analyse manquait probablement de puissance quant à certains critères d’évaluation , aucune différence dans l’incidence d’événements indésirables graves n’a été observée avec l’administration d’ASE et de fer par rapport à une administration de fer seul .