***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: Forty patients who were scheduled for a total hip arthroplasty were enrolled in a prospect i ve study and were r and omly divided into two groups . Group 1 received recombinant human erythropoietin ( 300 U/kg twice a week ) , and group 2 received placebo . The medication was started 2 weeks before the operation , and only one dose of medication was given after the operation . Autologous blood was administered at the same time as the medication until the hemoglobin level sank to 10 g/dl . Forty-eight and 49 units of autologous blood were collected in group 1 and group 2 , respectively . Intraoperative homologous blood was transfused only to patients in group 2 . Seven and 13 units of allogenic blood were transfused into group 1 and group 2 patients during the postoperative period , respectively . There were no any significant differences between the groups in terms of early postoperative hemoglobin level and amount of autologous blood collected . However , the increase of the reticulocyte count in patients who received erythropoietin was significantly higher than in the group 2 patients . The study showed that short-term and low-dose erythropoietin usage strongly stimulates the bone marrow . Erythropoietin administration and preoperative autologous blood donation diminished the total units of allogenic blood required during the intraoperative or postoperative pe-riod . Autologous blood administration without concurrent erythropoietin did not stimulate the bone marrow adequately This prospect i ve r and omized trial compared preoperative autologous blood donation ( PAD ) with epoetin alfa in patients undergoing primary total knee reconstruction . Fifty adult patients with pretreatment hemoglobin level of 100 to 130 g/L were r and omized to either epoetin alfa 40,000 U at preoperative days 14 and 7 or to a st and ard PAD protocol . Patient characteristics and operative blood loss were similar between groups . Baseline hematological parameters for epoetin alfa vs PAD were not significantly different ; however , by the day of surgery the epoetin alfa group had significantly higher hemoglobin ( 130 vs 114 g/L ; P < .001 ) , hematocrit ( 0.408 vs 0.352 ; P < .001 ) , and reticulocyte count ( 3.4 vs 2.1 x 10(9 ) cells per liter ; P < .001 ) . These differences remained significant for 1 to 2 days postoperatively . There was no significant difference in the incidence of allogeneic transfusions between groups ( 28 % for epoetin alfa vs 8 % for PAD ; P = .1383 ) . Both treatments were generally well tolerated .  Epoetin alfa appears to be a safe alternative to PAD in patients who are at risk for transfusion in the perioperative period following total knee arthroplasty Abstract Recombinant human erythropoietin ( rHuEPO ) is effective in allowing autologous blood donation in patients unable to donate because of anemia . As adverse effects of rHuEPO might include activation of coagulation and possibly fibrinolysis , we investigated these possibilities in the context of autologous blood donation preceding hip surgery . Thirty-seven patients who donated 800 ml of autologous blood for elective hip surgery were r and omly assigned to either a group of 20 receiving preoperative treatment with rHuEPO ( erythropoietin β ) , 6000 U i.v . twice weekly for 3 weeks , or an untreated control group of 17 . A significant increase in platelet count was associated with autologous blood donation and intraoperative blood loss with or without rHuEPO  . Coagulation and fibrinolysis were increased significantly by intraoperative blood loss in both groups , but not by rHuEPO . Coagulation and fibrinolysis were not activated by rHuEPO for elective hip surgery In a prospect i ve r and omized study we investigated the potential of subcutaneous recombinant human erythropoietin ( rhEpo ) as adjuvant treatment for autologous blood transfusions ( 3 units ) in elective surgery . Four and 2 weeks before surgery , 49 patients received 6 x 10,000 U of rhEpo .  delta Hb values ( days -28 and 0 ) of the rhEpo group were compared to delta Hb values of 52 controls ( no rhEpo ) . Reticulocytes were measured at days -21 , -14 , -7 and 0 . Peri- and postoperative supplementary homologous blood requirements were compared in the two r and omized groups . delta Hb of rhEpo group was 0.96 g/dl ( mean value ) and 2.38 for controls . Reticulocyte count increased earlier and to higher levels in rhEpo-treated patients . Except in 1 case ,  Epo was well tolerated . These results indicate that autologous predonation ( 3 x 400 ml ) does not create anemia if adjuvant Epo treatment is given . However , homologous blood requirements were not significantly different , which is probably due to the fact that 96 of the 101 treated patients underwent elective orthopedic surgery requiring limited blood replacement . Significant benefit of the Epo regimen can be expected in elective cardiovascular and hepatic surgery where larger amounts of blood ( 5 - 6 units ) are needed 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 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 high dose of oral iron used in conjunction with a more prolonged epoetin alfa dosing schedule might produce a better hematologic response than that obtained with the st and ard regimen . We therefore evaluated the efficacy of two different epoetin alfa dose regimens . Methods Patients The study was a double-blind , r and omized , parallel-group , multicenter clinical trial comparing the efficacy of epoetin alfa ( Eprex , Janssen-Ortho Inc. , Toronto , Ontario , Canada ) with placebo in adult patients undergoing total hip joint arthroplasty . The trial was conducted at 13 teaching and 4 community hospitals in Canada from May 1996 to April 1999 . The protocol was approved by the institutional review board of each participating center . Eligible patients had a hemoglobin concentration of 98 to 137 g/L and did not predonate blood . At centers where an autologous blood donation program was available , blood predonation was discussed with patients ; those who participated in the study were either ineligible for predonation because of medical contraindication or declined this option . Persons with rheumatoid arthritis , recent gastrointestinal or intracranial bleeding , iron deficiency , seizures , blood dyscrasias , or uncontrolled hypertension ( diastolic blood pressure>100 mm Hg ) were excluded from the study . Patients who required revision arthroplasty or those in whom red cell salvage devices were considered essential were not enrolled . All patients gave written informed consent . Baseline and R and omization Procedures Participants were screened for eligibility 7 weeks before surgery . A history and physical examination were performed , and a complete blood count , iron studies , and blood chemistry were obtained ; patients then began oral iron therapy . Six weeks before surgery , eligible patients were r and omly assigned to one of three treatment groups . R and omization was performed according to a computer-generated schedule using a block size of 13 and an allocation ratio of 3:5:5 to the high-dose epoetin group , low-dose epoetin group , or placebo group , respectively . Treatment Regimens Patients began daily oral iron therapy at least 42 days before surgery and continued therapy until the day of hospital discharge . Three capsules per day were recommended . In patients who were intolerant of iron , the number of capsules was reduced to the point of tolerability . The iron preparation prescribed was Niferex-150 ( Schwarz Pharma , Mequon , Wisconsin ) . This polysaccharideiron complex was selected because of its good tolerability and high bioavailability of elemental iron ( 150 mg per capsule ) ( 25 ) . Patients received four weekly subcutaneous injections of placebo , high-dose epoetin alfa ( 40 000 U ) , or low-dose epoetin alfa ( 20 000 U ) starting 4 weeks before surgery . The total possible dose was 160 000 U in the high-dose group and 80 000 U in the low-dose group . The study drug was withheld if the hemoglobin concentration was 150 g/L or more , systolic blood pressure was 200 mm Hg or more , or the diastolic blood pressure was 105 mm Hg or more . During the trial , the study coordinator at the data coordinating center , who was aware of the patient 's hemoglobin concentration , authorized administration of study drug before each visit . This person had no contact with patients 
    Output:
    
The results also indicated EPO  does not increase the risk of a venous thromboembolism event .
Conclusion Preoperative administration of EPO was shown to generally increase Hb levels during the whole perioperative period ; however , the extent of the positive effects varies with time points .
Additionally , EPO minimizes the need for transfusion significantly in patients undergoing hip or knee surgery without increasing the chance of developing thrombotic complications .
Therefore , EPO offers an alternative blood management strategy in total hip arthroplasty and total knee arthroplasty