Dh. Biesma et al., LOWER HOMOLOGOUS BLOOD REQUIREMENT IN AUTOLOGOUS BLOOD-DONORS AFTER TREATMENT WITH RECOMBINANT-HUMAN-ERYTHROPOIETIN, Lancet, 344(8919), 1994, pp. 367-370
The risk of blood-borne diseases has substantially increased the use o
f autologous blood transfusion. Many autologous donors, however, still
need homologous transfusions. To find out whether recombinant erythro
poietin (rhEPO) reduces requirements for homologous blood transfusion,
we carried out a randomised, controlled trial, in which patients were
stratified according to blood volume. We studied 95 autologous blood
donors undergoing elective hip surgery. 50 patients were randomly assi
gned 500 U/kg rhEPO subcutaneously twice a week for 3 weeks, and 45 pa
tients received no treatment (control group). The patients each donate
d two units of blood before surgery. Only 5 (10%) rhEPO-treated patien
ts received homologous transfusions compared with 16 (36%) controls (p
<0.01). rhEPO was most useful in patients with a blood volume below 4
L and an estimated blood loss below 2 L or with a blood volume of 4-5
L and blood loss of 1-2 L. Continued administration of rhEPO caused no
further increase in reticulocyte counts after the fourth injection, w
hich was accompanied by a pronounced depletion of storage iron. rhEPO
treatment had no effect on renal function, platelet count, or blood pr
essure. Subcutaneous rhEPO is an effective and safe way to reduce expo
sure to homologous blood in autologous donors. Its use can be restrict
ed to a subpopulation of autologous blood donors, which improves the c
ost-effectiveness of this expensive approach.