THE EFFECT OF PATIENT SIZE AND DOSE OF RECOMBINANT-HUMAN-ERYTHROPOIETIN THERAPY ON RED-BLOOD-CELL VOLUME EXPANSION IN AUTOLOGOUS BLOOD-DONORS FOR ELECTIVE ORTHOPEDIC OPERATION

BACKGROUND: Recombinant human erythropoietin (EPO) therapy has been kn own to enhance erythropoiesis and facilitate autologous blood donation before elective orthopedic operations. However, the optimal EPO dose in this setting remains undefined. To help determine this, we have exa mined the effect of patient weight and EPO dose on red blood cell (RBC ) volume expansion. STUDY DESIGN: Forty-six nonanemic autologous blood donors enrolled at our institution in two previously reported multice nter clinical trials were analyzed. Patients received either placebo o r EPO (150, 300, or 600 units [U] per kg) given intravenously at each of six AB blood type donation visits. RESULTS: Total preoperative RBC volume expansion over a 22 day period was 465 +/- 135 mL, (mean +/-SD) in patients receiving a placebo and 588 +/- 201 mL, 735 +/- 144 mL, a nd 881 +/- 299 mL in patients receiving graded concentrations of EPO. When RBC volume increase was corrected for patient weight and EPO dose , patients receiving placebo or EPO (150, 300, and 600 U per kg) expan ded RBC volume by 5.9 mL per kg in patients receiving placebo and 7.9, 9.1, and 10.9 mL per kg in patients receiving EPO, respectively (p<0. 02 for each EPO group compared with placebo group). A direct relations hip between EPO dose and RBC volume increase (response) over 22 days w as determined by the linear regression equation: RBC volume increase ( response) over 22 days was determined by the linear regression equatio n: RBC volume (mL per kg)=6.34+0.0013X, r=0.98, where X equals total u nits EPO administered (per kg body weight). CONCLUSIONS: We conclude t hat EPO dose can be based on anticipated blood losses and transfusion needs in autologous blood donors before orthopedic operation.