THE PERIOPERATIVE USE OF RECOMBINANT ERYT HROPOIETIN (RHEPO) IN JEHOVAH-WITNESSES

Erythropoietin, the hematopoietic growth factor, is synthesised in the kidneys and liver and regulates red blood cell production. Within the last few years, recombinant DNA technology has produced synthetic ery thropoietin (rhEPO). Some patients, especially Jehova's Witnesses, wil l not accept blood transfusion. The perioperative administration of rh EPO increases the patients' hematocrit (HCt) to a higher than physiolo gical level. Methods and results. We report a case of a 66-year-old fe male Jehova's Witness who refused blood transfusions and responded fav ourably to rhEPO treatment. A total hip arthroplasty was planned. A pr etreatment hemoglobin level (Hb) of 13.7 g/dl and HCt of 43% were docu mented. After preoperative subcutaneous application of 5000 I.E. rhEPO three times per week and daily oral substitution of 300 mg ferrous su lfate over a period of 3 weeks, the Hb increased to 15.5 g/dl and the HCt to 49%. The operation was carried out after the ninth application of rhEPO, Postoperatively, the Hb concentration was 11.8 g/dl and the HCt 35%. Therefore, postoperative administration of rhEPO was not cons idered indicated. No side effects of rhEPO application were noted. The patient left hospital on the 10th postoperative day. Conclusions. The case report describes perioperative management using human rhEPO in J ehova's Witnesses. Treatment with rhEPO increases preoperative Hb leve ls to a point making it possible to compensate for operative blood los s. RhEPO combined with daily iron substitution may be useful in patien ts who refuse transfusion based on religious convictions.