The variability of compensatory erythropoiesis in repeated autologous blood donation

BACKGROUND: Compensatory RBC production during repeated preoperative autolo gous blood donation (PABD) shows marked interindividual variability. This s tudy was performed to reveal variables that might be useful to predict the amount of the erythropoietic response to PABD in an individual patient who was not iron deficient. STUDY DESIGN AND METHODS: In a retrospective study, 104 adult patients, 48 women and 56 men (mean age, 59.9 years; range, 18-82 years) who donated 3 u nits (450 mL) of autologous blood at weekly intervals for major surgery wer e investigated. Blood counts, ferritin, and net preoperative RBC production (net RBC production) were determined in all patients, and soluble transfer rin receptor and endogenous levels of EPO, SCF, and IL-1 beta were measured in 63 patients. Multiple linear regression analysis was used to determine whether the variance of net RBC production was attributable to baseline val ues of these variables. RESULTS: Net RBC production was not different in patients who received oral iron and patients who did not (384 +/- 222 mt vs. 356 +/- 158 mt). In both groups, the same two variables consistently showed a significant relations hip to net RBC production: the length of the period between the third donat ion and the last visit was positively related (p = 0.00001 vs. p = 0.0002) and the Hct at baseline was negatively related (p = 0.0002 vs, p = 0.02) wi th net RBC production. The proportion of variance in net RBC production tha t was attributable to these two variables was 48.1 percent(r(2) = 0.481) an d 34.9 percent (r(2) = 0.349), respectively. CONCLUSION: RBC production after PABD increases with increasing interval fr om last donation to surgery. This suggests that the interval from last dona tion to surgery should be maximized. This can be achieved by organizational measures in combination with the preparation of RBC concentrates in additi ve solution with a maximum shelf life.