Rapid restoration of red blood cell mass in severely anemic surgical patients who refuse transfusion.

Optimal parenteral nutritional support, concomitant with replacement doses of intravenous iron dextran injection, can be safe, effective, and lifesaving for severely anemic patients who are unable to receive blood transfusions. Six patients who had sustained massive acute blood loss and two who had severe chronic anemia received as much as 140 mL of iron dextran injection intravenously. The average initial hemoglobin level in the acute group was 5.0 g/dL (range, 2.6 to 8.4 g/dL) and increased to an average of 10.6 g/dL (range, 7.5 to 12.8 g/dL) in 23 days (range, 17 to 30 days); the hemoglobin level in the chronic group was 3.8 g/dL and increased to 10.6 g/dL over an average period of 121 days. Two total abdominal colectomies, a right transverse colectomy and fistulectomy, a pyloroplasty and vagotomy, and a highly selective vagotomy were accomplished without complications in five of the patients. There were no adverse reactions to the hematopoietic therapy.