HAS RECOMBINANT-HUMAN-ERYTHROPOIETIN THERAPY MINIMIZED RED-CELL TRANSFUSIONS IN HEMODIALYSIS-PATIENTS

We have conducted a six-year (1986-1991) review of our transfusion ser vice to identify the frequency of blood transfusions in patients under going chronic hemodialysis, before and after availability of recombina nt human erythropoietin (EPO) as an alternative to allogeneic blood. F our hundred forty-nine patients who underwent a total of 54,999 dialys is events were reviewed. Overall, 343 (76%) of 449 patients received 4 ,864 red-cell transfusions during 54,929 dialysis events. Red-cell uni ts transfused per patient were significantly lower in 1991 compared to the year (1988) prior to EPO (5.3+/-4.5, M + SD, vs 8.6+/-13.4, p=0.0 2) but not compared to 1986 (6.4+/-6.4, p=0.11). The frequency of red- cell transfusions per 100 dialysis events declined substantially when 1991 was compared to 1988 (4.11 vs 13.35, p<0.01) but less so when 199 1 was compared to 1986 (4.11 vs 6.20, p<0.01). Overall, 4864 red-cell units transfused to dialysis patients accounted for 4.46% of 109,159 r ed-cell units released by our transfusion service, decreasing from 7.3 % in 1988 to 2.0% in 1991. We conclude 1) the availability of EPO in 1 989 was accompanied by a significant reduction in the frequency of red -cell exposure in patients undergoing dialysis from 1988, but the redu ction was less impressive when compared to 1986. 2) Attention to EPO d osage, concomitant causes of anemia, and resistance to EPO therapy in this setting may be required to take full advantage of this biotechnol ogic alternative to blood transfusion.