EVALUATION OF ERYTHROPOIETIC ACTIVITY ON THE BASIS OF THE RED-CELL AND RETICULOCYTE DISTRIBUTION WIDTHS DURING EPOETIN-BETA THERAPY IN PATIENTS UNDERGOING CARDIAC-SURGERY

The changes in the red cell and reticulocyte distribution widths durin g preoperative treatment with recombinant human erythropoietin (rhEPO) were evaluated in a double-blind, placebo-controlled trial in cardiac surgery patients. The increases in the reticulocyte count, in the hem oglobin and in all distribution widths are the expression of the marke d preoperative stimulation of erythropoiesis in the patients treated w ith rhEPO. Only placebo patients with a hemoglobin less than or equal to 7.5 mmol/l or a transferrin >4.0 g/l at baseline showed an increase in the red cell distribution width or in the reticulocyte hemoglobin distribution width on oral iron therapy alone. While the reticulocyte count and the distribution widths of red cells in the rhEPO patients d ecreased postoperatively, only the increases in the distribution width s of reticulocytes after the second postoperative day indicate that st imulation of erythropoiesis had taken place. In patients with a low he moglobin or a high transferrin the rhEPO therapy should be preceded by iron therapy in order to raise the hemoglobin level and reduce the co st of treatment.