THE EFFECT OF RECOMBINANT-HUMAN-ERYTHROPOIETIN ON HEMOSTASIS, FIBRINOLYSIS, AND BLOOD THEOLOGY IN AUTOLOGOUS BLOOD-DONORS

Treatment with recombinant human erythropoietin (rhEPO) for the anemia of endstage renal disease has been associated with thrombotic complic ations. To detect prothrombotic changes in autologous blood donors giv en 500 U/kg rhEPO subcutaneously (twice weekly during a 3-week period) , changes in variables of hemostasis and fibrinolysis and in blood the ology before and at the end of treatment were investigated. In 21 pati ents, platelet count increased from 272 +/- 55 x 10(9)/L to 313 +/- 55 x 10(9)/L (p < 0.05). Although activated partial thromboplastin time and protein C antigen decreased significantly during rhEPO treatment, these changes remained within normal ranges. No changes in the hemosta tic variables prothrombin time, fibrinogen, factor V, von Willebrand f actor antigen, antithrombin III activity, protein S antigen, and proth rombin fragments F 1 + 2 were found. Measurements of plasminogen activ ity, alpha(2)-antiplasmin activity, tissue plasminogen activator, and plasminogen activator inhibitor-1, representing variables of fibrinoly sis, were normal and constant during the study. In 5 patients no chang es in red cell deformability and whole blood viscosity, corrected for differences in hematocrit, were observed. Plasma viscosity showed a sl ight but clinically not relevant increase in 4 out of 5 patients. The absence of evident (pro)thrombotic changes in this study confirms the safety of high-dose rhEPO therapy in autologous blood donors, who dona te 2 units (i.e., 2 x 450 ml) blood.