Editing Anemia (section)

===Erythropoiesis-stimulating agents===
The objective for the administration of an [[erythropoiesis-stimulating agent]] (ESA) is to maintain hemoglobin at the lowest level that both minimizes transfusions and meets the individual person's needs.<ref name="2007anemiaESA">{{cite journal | vauthors = Aapro MS, Link H | title = September 2007 update on EORTC guidelines and anemia management with erythropoiesis-stimulating agents | journal = The Oncologist | volume = 13 Suppl 3 | issue = Supplement 3 | pages = 33–36 | year = 2008 | pmid = 18458123 | doi = 10.1634/theoncologist.13-S3-33 }}</ref> They should not be used for mild or moderate anemia.<ref name=Kan2013/> They are not recommended in people with [[chronic kidney disease]] unless hemoglobin levels are less than 10 g/dL or they have symptoms of anemia. Their use should be along with parenteral iron.<ref name="2007anemiaESA"/><ref name="ASNfive">{{Citation |author1 = American Society of Nephrology |author1-link = American Society of Nephrology |title = Five Things Physicians and Patients Should Question |publisher = [[American Society of Nephrology]] |work = Choosing Wisely: an initiative of the [[ABIM Foundation]] |url = http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Soc_Neph.pdf |access-date = August 17, 2012 |url-status = live|archive-url = https://web.archive.org/web/20120416220524/http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Soc_Neph.pdf |archive-date = April 16, 2012 }}</ref> The 2020 Cochrane Anaesthesia Review Group review of erythropoietin (EPO) plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery <ref>{{cite journal | vauthors = Kaufner L, Heymann C | title = Erythropoietin plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery | journal = Cochrane Database of Systematic Reviews | year = 2020 | volume = 2020 | issue = 8 | pages = CD012451 | doi = 10.1002/14651858.CD012451.pub2 | pmid = 32790892 | pmc = 8095002 }}</ref> demonstrated that patients were much less likely to require red cell transfusion and in those transfused, the volumes were unchanged (mean difference -0.09, 95% CI -0.23 to 0.05). Pre-operative hemoglobin concentration was increased in those receiving 'high dose' EPO, but not 'low dose'.{{citation needed|date=November 2021}}