PERIOPERATIVE USE OF RECOMBINANT-HUMAN-ERYTHROPOIETIN IN PATIENTS REFUSING BLOOD-TRANSFUSIONS - PATHOPHYSIOLOGICAL CONSIDERATIONS BASED ON 5 CASES

The efficacy of the administration of recombinant human erythropoietin (rHuEPO) in the treatment of anaemia in critically ill surgical patie nts refusing red cell transfusions requires further documentation. Her ein, we report the outcome of 5 consecutive severely anaemic Jehovah's Witness patients (lowest haemoglobin concentration 27 g/l), who were discharged from the hospital in good condition after treatment. RHuEPO (50-280 U/kg body weight) was daily administered to 4 of the patients , who either exhibited preoperative anaemia or developed postoperative anaemia refractory to endogenous EPO probably due to inflammation. RH uEPO treatment was followed by a steep rise in reticulocytes and haemo globin concentration. The fifth patient, who exhibited no signs of sys temic inflammation following emergency hemicolectomy, was also treated with intravenous iron, but not with rHuEPO. His blood haemoglobin con centration rose from 27 g/l to 92 g/l in 3 wk. These observations indi cate that the administration of rHuEPO is justified in the management of life-threatening anaemia, although only on a humanitarian basis, be cause there is no predictor for the possible spontaneous recovery.