Preoperative treatment with recombinant human erythropoietin or predepositof autologous blood in women undergoing primary hip replacement

Background: Controversy exists about the advantages of predeposit of autolo gous blood (PDAB), and whether more comfortable blood conservation regimens may yield comparable results. To test the hypothesis that preoperative tre atment with recombinant human erythropoietin (rHuEPO) with or without acute concomitant normovolaemic haemodilution (ANHD) is as effective as PDAB in reducing allogeneic blood transfusions, we conducted a prospective randomis ed study in women undergoing primary hip replacement. Methods: Sixty consecutive female patients scheduled for primary hip replac ement and suitable for PDAB were randomly assigned to one of: 3 groups. Gro up I(EPO) and LI (ANHD) received 600 U/kg rHuEPO s.c. and 100 mg iron sacch arate i.v. on day 14 and, if needed, on day 7 before surgery. Additionally, in group II acute normovolaemic haemodilution (ANHD) was implemented after induction of anaesthesia. In group III (PDAB) conventional PDAB up to 3 U, without volume replacement but with concomitant oral iron therapy, was per formed starting 4 weeks before surgery. Results: The blood conservation methods resulted in a comparable net gain o f red cells in all 3 groups until the day of surgery. Because of the withdr awal of autologous blood, haemoglobin values before surgery were lower in t he PDAB group than in the EPO and ANHD groups, and during surgery were lowe r in the PDAB and ANHD groups than in the rHuEPO-only group. Applying moder ate ANHD in conjunction with preoperative rHuEPO treatment did not yield an incremental decrease in allogeneic transfusions. There was no difference b etween the groups in the number of patients who received allogeneic transfu sions or in the total number of allogeneic units transfused. Conclusions: Withdrawal of autologous blood is associated with lower pre- a nd intraoperative haemoglobin levels when compared to preoperative augmenta tion of red cell mass using rHuEPO. As a measure to reduce allogeneic trans fusion requirements, preoperative treatment with rHuEPO may be as effective as standard predeposit of autologous blood in women undergoing primary hip replacement, but requires less preoperative time. (C) Acta Anaesthesiologica Scandinavica 44 (2000).