Effect of human recombinant erythropoietin on reduction of homologous blood transfusion in open-heart surgery. A Japanese Multicenter study.
BACKGROUND
Recombinant human erythropoietin (EPOCH) has been shown to increase erythropoiesis; therefore, EPOCH has been used in conjunction with autologous blood predonation (ABP) before surgery. However, the administration methods of EPOCH to obtain an adequate volume of ABP before open-heart surgery have not been determined.


RESULTS
The effects of EPOCH on harvesting ABP and decreasing homologous blood transfusion (HBT) in open-heart surgery were examined prospectively in 205 patients treated in a 29-institute multicenter study. Single dose of 3,000, 6,000, or 9,000 IU of EPOCH were administered for 2 weeks (two or three times per week) without ABP (group 1, n = 69) or for 3 weeks (two or three times per week) with ABP (group 2, n = 97) and compared with control subjects (n = 39). Preoperative blood hemoglobin increase (delta Hb[g/dl]) was < 1.0 g/dl in group 1. When EPOCH was given three times a week, the delta Hb in each subgroup of group 2 was 0.6 +/- 1.1 (control), 2.1 +/- 1.3 (3,000 IU), 2.4 +/- 1.4 (6,000 IU), and 2.8 +/- 1.5 (9,000 IU), which was significantly higher than the control (p < 0.05) and was dose dependent. The HBT rates in patients with a moderate perioperative blood loss of between 15 and 50 ml/kg were 75.0% (control), 35.7% (3,000 IU), 52.9% (6,000 IU), and 66.7% (9,000 IU) in group 1, and respective volumes in group 2 were 40.0% (control), 20.0% (3,000 IU), 26.9% (6,000 IU), and 12.5% (9,000 IU). The overall HBT rate of EPOCH-treated patients with a moderate blood loss was 50% (20 of 40) in group 1 and 21% (13 of 62) in group 2. The HBT rate was significantly reduced by combination of preoperative EPOCH treatment (three times per week) and ABP (p < 0.0001).


CONCLUSIONS
Dose-dependent increase of blood hemoglobin level was observed by EPOCH treatment with ABP; combination of EPOCH treatment and ABP can reduce HBT during open-heart surgery.
Kyo
S
S
First Department of Surgery, Saitama Medical School, Japan.
Omoto
R
R
Hirashima
K
K
Eguchi
S
S
Fujita
T
T
D001803:Blood Transfusion; D001804:Blood Transfusion, Autologous; D006348:Cardiac Surgical Procedures; D004334:Drug Administration Schedule; D004920:Erythropoiesis / Q000187:drug effects; D004921:Erythropoietin / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use
D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin