Recombinant human erythropoietin has been approved for use in patients unde
rgoing autologous donation in Japan, Europe, and Canada since 1993, 1994, a
nd 1996, respectively, and for perisurgical adjuvant therapy without autolo
gous donation in Canada and the United States since 1996, Early clinical tr
ials of erythropoietin therapy in the setting of autologous donation have p
rovided important information regarding clinical safety, erythropoietin dos
e, and erythropoietic response. Later trials of perisurgical erythropoietin
therapy without autologous donation provided data on efficacy (reduced all
ogeneic blood exposure) that led to approval of erythropoietin in patients
undergoing surgery. However, the erythropoietin doses (300 U/kg subcutaneou
s x14 days) used in these trials, and their subsequent inclusion in labelin
g for the use of this product, are costly and tedious to administer. A rece
nt study reported that a weekly regimen of erythropoietin (600 U/kg) for 4
weeks is less costly but just as effective at reducing allogeneic blood exp
osure in elective orthopaedic surgery. The most cost effective regimen that
has been shown to minimize allogeneic exposure is preoperative erythropoie
tin therapy (600 U/kg subcutaneous weekly x2 and 300 U/kg subcutaneous on d
ay of surgery) coupled with acute normovolemic hemodilution in patients und
ergoing radical retropubic prostatectomy. A similar regimen of erythropoiet
in therapy in patients undergoing coronary artery bypass grafting (2500 U/k
g subcutaneous in divided doses for 2 weeks preoperatively) coupled with he
modilution also was effective. Low dose erythropoietin therapy coupled with
acute normovolemic hemodilution ultimately may be shown to he cost equival
ent to the predonation of three autologous blood units before elective surg
ery.