Oral cancer resection and reconstruction without blood transfusion by using recombinant human erythropoietin

Chul-Hwan Kim; Chung-Hyun Lee

doi:10.5125/jkaoms.2011.37.9.9

Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(1) > 1032526

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Kim and Lee: Oral cancer resection and reconstruction without blood transfusion by using recombinant human erythropoietin

Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(1):9-14.

Published online: 10 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.9.9

Oral cancer resection and reconstruction without blood transfusion by using recombinant human erythropoietin

Chul-Hwan Kim, Chung-Hyun Lee

Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Choenan, Korea

Chul-Hwan Kim Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University San #29 Anseo-dong, Choenan, 330-714, Korea TEL: +82-41-550-1996 FAX: +82-41-551-8988 E-mail: kimchoms@dankook.ac.kr

Received 27 September 2010 Revised 13 December 2010 Accepted 20 January 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Recently, the population of patients who refuse transfusion has increased for both religious and non-religious reasons, even in life threatening emergency situations. Their refusal has highlighted the need to develop nonblood transfusion surgery techniques to decrease the risk from blood transfusions.

A 57-year woman with an ulcerative lesion on the gingiva of the right upper molar area visited the department of oral and maxillofacial surgery in Dankook University Dental Hospital. After a preliminary evaluation, the patient was diagnosed with squamous cell carcinoma. As she refused blood transfusion during surgery for religious reasons, surgery was planned using recombinant human erythropoietin (rHuEPO) without a blood transfusion. The patient underwent a partial maxillectomy, supraomohyoid neck dissection, free radial forearm flap and split thickness skin graft under general anesthesia. rHuEPO and iron were used before and after surgery. The hemoglobin/hematocrit (Hb/Hct) level, iron (Fe) and total iron-binding capacity (TIBC) were assessed. The patient recovered completely without any blood transfusions. rHuEPO is a viable alternative for patients with religious objections to receiving blood transfusions.

Keywords: Recombinant erythropoietin, Blood transfusion, Mouth neoplasms

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Fig. 1.

Intraoral view of gingival lesion on maxilla, showing ulcerative lesion 2×3 cm diameter.

Fig. 2.

Coronal and axial MRI (contrast-enhanced T1-weighted) showing soft tissue mass on right upper buccal mucosa and right hard palate.(MRI: magnetic resonance imaging)

Fig. 3.

F¹⁸-FDG-PET showing uptake of FDG on right upper gingiva area.(F¹⁸-FDG-PET: F¹⁸-fluorodeoxyglucose positron emission tomography)

Fig. 4.

Recombinant human erythropoietin 4,000 unit/0.4 mL.

Fig. 5.

Intraoperative view of case. A. Incision line for supraomohyoid neck dissection. B. Partial maxillectomy. C. Application of free radial forearm flap. D. Split thickness skin graft.

Table 1.

The changes of complete blood cell count (CBC), serum iron (Fe), TIBC, UIBC during pre- and postoperative period

	WBC (1,000/mL)	RBC (10⁶/mL)	Hemoglobin (g/dL)	Hematocrit (%)	Platelet count (1,000/mL)	Iron (Fe) (㎍/dL)	TIBC (㎍/dL)	UIBC (㎍/dL)
Admission	4.26	4.45	12.5	38.7	190	123	347	224
Before surgery	4.04	4.65	12.5	40.1	199	−	−	−
After surgery	11.78	3.26	9.3	28.5	210	−	−	−
POD #1	10.71	3.09	8.7	26.7	185	13	200	187
POD #3	10.16	2.21	6.2	19.3	128	−	−	−
POD #4	8.30	2.05	5.9	18.2	120	54	191	137
POD #5	9.66	2.06	5.8	18.2	122	150	196	46
POD #7	6.86	2.45	6.9	22.4	133	−	−	−
POD #8	5.57	2.57	7.2	23.4	150	34	246	212
POD #9	5.44	2.49	7.1	23.1	137	85	257	172
POD #11	5.01	2.43	7.1	22.9	137	26	239	213
POD #14	2.57	2.35	6.7	22.5	117	−	−	−
POD #16	2.42	2.34	6.7	22.8	141	19	189	170
POD #17	2.86	2.44	6.9	24.0	161	53	196	143
POD #21	2.60	3.02	8.3	29.2	229	−	−	−
POD #24	2.23	3.34	8.7	31.4	190	17	276	259
POD #36	4.91	3.87	9.7	33.1	246	21	329	308
POD #43	4.12	4.26	10.5	35.4	234	18	326	308

(TIBC: total iron-binding capacity, UIBC: unsaturated iron binding capacity, WBC: white blood cell, RBC: red blood cell, POD: post-operative day)

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