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.