Epoetin alfa - A bloodless approach for the treatment of perioperative anemia

Under normal physiologic conditions the level of circulating red blood cell s is regulated precisely by the glycoprotein erythropoietin. In major elect ive surgery, patients who are participating in preoperative autologous bloo d donation or who are anemic may not have the capacity to manufacture suffi cient red blood cells in response to increases in endogenous erythropoietin that is sufficient to avoid perioperative allogeneic blood transfusion. In these patients pharmacologic doses of recombinant human erythropoietin (Ep oetin alfa) have been shown to accelerate erythropoiesis, thereby increasin g preoperative red blood cell production, hematocrit level, and hemoglobin concentration and reducing exposure to allogeneic blood transfusion. In fou r large multicenter studies, 869 patients undergoing major elective surgery were treated with a daily regimen (300 or 100 IU/kg x 14 or 15 doses) or a weekly regimen (600 IU/kg x 4 doses) of subcutaneous Epoetin alfa beginnin g either 2 or 3 weeks before surgery, respectively. Although all Epoetin al fa regimens were effective at accelerating erythropoiesis and increasing re d blood cell production, the,weekly regimen was the most patient friendly, cost effective regimen for treating preoperative anemia and minimizing pati ent risk of allogeneic blood transfusion.