ERYTHROPOIETIN THERAPY DURING FREQUENT AU TOLOGOUS BLOOD DONATIONS - DOSE-FINDING STUDY

Avoidance of homologous blood products and patients' demand for preope rative autologous blood donation programs are increasing. As many of t hese patients are older, with a compromised cardiovascular system and a slow response of the erythropoietic system when anemia occurs, the f easibility and benefit of autologous blood donation is often limited. Augmentation of preoperative blood donation by therapy with recombinan t human erythropoietin (rHuEPO) has been described in animal models an d in patients. Methods. In a multicenter, controlled, randomized trial , 49 patients scheduled for orthopaedic or vascular surgery received 0 (control group, n=9), 200 (n=10), 300 (n=11), 400 (n=10) or 500 (n=9) U/kg rHuEPO (Erypo, Cilag, Sulzbach, distributor Fresenius, Oberursel , Germany) subcutaneously twice a week for 3 weeks while every week 45 0 mi blood was collected. Iron sulphate 100 mg was prescribed orally t wice a day. Patients were ineligible if they had uncontrolled hyperten sion, recent myocardial infarction, haematological disorders or a hist ory of seizures. Blood donation had to be cancelled if the haematocrit was below 30%. Results. There was a significant (ANOVA) drop of the h aematocrit value only in the control group, and end-point values for h aematocrit and haemoglobin were significantly elevated in the 400 and 500 U/kg groups compared with the control group (Table 9). Discussion. The erythropoietic stimulus of phlebotomy for autologous blood donati ons is often not efficient enough to guarantee a constant haematocrit. Lowering of the preoperative haematocrit jeopardizes the aim of avoid ance of homologous blood transfusions. rHuEPO increased the efficiency of autologous blood collections, as predonation haematocrit values co uld be preserved in the high-dosage groups. As a consequence, homologo us transfusions could be avoided. However, there were broad interindiv idual differences in the erythropoietic response, possibly due to limi tations in iron availability. Adverse effects of rHuEPO therapy, such as hypertension, thrombosis or neurologic disorders, are mostly report ed in patients with terminal kidney failure. No such disturbances were observed in the present study. Conclusion. rHuEPO ameliorates the pre operative decrease of haemoglobin and haematocrit values due to autolo gous blood donations in a dose-related fashion. The individually adjus ted dosage of rHuEPO and iron supplementation merits further investiga tion.