ERYTHROPOIESIS, ERYTHROPOIETIN, AND IRON-METABOLISM IN ELECTIVE SURGERY - PREOPERATIVE STRATEGIES FOR AVOIDING ALLOGENEIC BLOOD EXPOSURE

Preoperative autologous donation (PAD) of blood and administration of recombinant human erythropoietin (Epoetin alfa) are two strategies for increasing red blood cell (RBC) mass preoperatively. The success of P AD depends primarily on the patient's ability to manufacture new RBCs before surgery to replace those removed during PAD. Red blood cell man ufacture depends in turn on adequate supplies of iron and the increase d renal production of endogenous erythropoietin following PAD. Success ful PAD also requires adequate time for regeneration of predonated RBC s. Parenteral administration of Epoetin alfa causes a dose-dependent s timulation of RBC production. Its use has been studied as an adjunct t o PAD and as a method to enhance endogenous erythropoiesis without PAD . Several studies suggest that administration of Epoetin alfa, begun m ic hemodilution. several days before surgery, may stimulate erythropoi esis and help decrease the number of RBC transfusions required postope ratively. The precise role of Epoetin alfa in the surgical setting is not yet established, and optimal dosage regimens have not been determi ned.