A prospective randomized comparison of three blood conservation strategiesfor radical prostatectomy

Background: Preoperative autologous blood donation is a standard of care fo r elective surgical procedures requiring transfusion. The authors evaluated the efficacy of alternative blood-conservation strategies including preope rative recombinant human erythropoietin (rHuEPO) therapy and acute normovol emic hemodilution (ANH) in radical retropubic prostatectomy patients. Methods: Seventy-nine patients were prospectively randomized to preoperativ e autologous donation (3 U autologous blood); rHuEPO plus ANH (preoperative subcutaneous administration of 600 U/kg rHuEPO at 21 and 14 days before su rgery and 300 U/kg on day of surgery followed by ANH in the operating room) ; or ANH (blinded, placebo injections per the rHuEPO regimen Listed previou sly). Transfusion outcomes, perioperative hematocrit levels, postoperative outcomes, and blood-conservation costs were compared among the three groups . Results: Baseline hematocrit levels were similar in all groups (43% +/- 2%) . On the day of surgery hematocrit decreased to 34% +/- 4% in the preoperat ive autologous donation group (P < 0.001), increased to 47% +/- 2% in the r HuEPO plus ANH group (P < 0.001), and remained unchanged at 43% +/- 2% in t he ANH group. Allogeneic blood exposure was similar in all groups. The rHuE PO plus ANH group had significantly higher hematocrit levels compared with the other groups throughout the hospitalization (P < 0.001). Average transf usion costs were significantly lower for ANH ($194 +/- $192) compared with preoperative autologous donation ($690 +/- $128; P < 0.001) or rHuEPO plus ANH ($1,393 +/- $204, P < 0.001). Conclusions: All three blood-conservation strategies resulted in similar al logeneic blood exposure rates, but ANH was the least costly technique. Preo perative rHuEPO plus ANH prevented postoperative anemia but resulted in the highest transfusion costs.