IRON AND ERYTHROPOIETIN MEASUREMENT IN AUTOLOGOUS BLOOD-DONORS WITH ANEMIA - IMPLICATIONS FOR MANAGEMENT

Background: The importance of autologous blood donation for elective s urgery is recognized, and the method is being used at many hospitals. Not all patients are able to deposit a sufficient amount of blood befo re surgery because they cannot recover rapidly enough from phlebotomy- induced anemia. The ability to donate sufficient blood for autologous use was studied in patients who are particularly susceptible to phlebo tomy-induced anemia. Study Design and Methods: Of 840 patients who don ated blood for autologous use in elective surgery from November 1987 t hrough May 1993, 20 with rheumatoid arthritis, 24 with iron deficiency anemia, and 37 aged 65 years and above with normocytic anemia were co mpared with 24 nonanemic elderly patients who donated a total of 1000 mL of blood for autologous use. Patients received iron sulfate orally and donated blood once a week until operation. Results: The amount of blood collected before surgery per control patient was more than that in others. Consequently, there was a tendency to allogeneic blood tran sfusion in patients with rheumatoid arthritis or elderly patients. The ferritin levels in controls and in patients with iron deficiency anem ia during the. donation period were almost within the normal range in spite of iron supplementation, which implied a good utilization of iro n sulfate for erythropoiesis. On the other hand, the rise in ferritin levels in the elderly and in patients with rheumatoid arthritis sugges ted inappropriate iron availability for erythropoiesis and resulted in an increase in iron storage. Since an adequate endogenous erythropoie tin response to phlebotomy-induced anemia was not observed in these pa tients, impaired erythropoietin production was considered one of the r easons for anemia. Conclusion: Patients with iron deficiency anemia ar e able to continue donating blood for autologous use so long as they h ave sufficient iron supplementation. However, the elderly or those wit h rheumatoid arthritis occasionally fail to donate a sufficient volume of blood before surgery as a result of phlebotomy-induced anemia; whi ch is caused in turn by impaired erythropoietin production.