EFFECT OF ADMINISTERING RHUEPO ASSOCIATED WITH ACUTE NORMOVOLEMIC HEMODILUTION ON TRANSFUSION NEEDS DURING SURGERY FOR TOTAL HIP-REPLACEMENT

Acute normovolaemic haemodilution (ANH) is used to avoid perioperative blood loss and consists of the withdrawal of whole blood lust before or lust after anaesthesia induction and its simultaneous replacement: by synthetic colloids and crystalloid solutions. In an attempt to impr ove the efficiency of this technique while at the same time avoiding c ardiovascular complications, we set up a pilot study to test the assoc iation of rHuEpo/ANH during elective surgery for total hip replacement . Five patients (3 males, 2 females) were included in this study. The amount of whole blood drawn was 3 x 450 ml from the men and 2 x 450 ml from the women. Before blood was taken, the mean increase in haemoglo bin was 1.2 +/- 0.9 g/dl and mean increase in reticulocytes 106 +/- 34 G/l. No patient received homologous transfusion during the peroperati ve: period; 3 patients received the totality of predonated blood and o ne patient 2 of the 3 units taken. The mean fall in haemoglobin at day 1 post-surgery was 3.6 g/dl. In conclusion, the stimulation of erythr opoiesis by rHuEpo in the pre-surgery phase led. on average to a 1 g/d l gain in haemoglobin, permitting an isovolaemic withdrawal of 900 to 1350 ml of blood depending on body weight without the development of s evere anaemia. It was thus possible to perform total hip replacement i n all the patients without homologous blood support and with a post-su rgery haemoglobin value of >10 g/dl. This protocol should be further t ested in a prospective randomised study (rHuEpo versus placebo) in ord er to assess the real benefit of rHuEpo.