Effectiveness of very low doses of subcutaneous recombinant human erythropoietin in facilitating autologous blood donation before orthopedic surgery.
BACKGROUND
Clinical and pharmacokinetic data suggest that very low doses of subcutaneous recombinant human erythropoietin (rHuEPO) may be effective in a preoperative autologous blood deposit program.


METHODS
Fifty-two patients, scheduled for orthopedic surgery, were enrolled in a double-blind and placebo-controlled study. Patients were randomly assigned to the placebo group or to receive 30, 60, or 100 IU per kg of rHuEPO subcutaneously twice a week for 2 weeks before surgery. The dose of rHuEPO that was effective in facilitating the collection of 4 units of blood in the 2 weeks before surgery and that prevented a sharp decrease in hematocrit was determined.


RESULTS
Only in patients receiving 100 IU per kg of rHuEPO did the outcome measurements differ significantly from those in the placebo group. With a higher (p < 0.01) cumulative increase in red cell volume during the study period (297 +/- 127 vs. 121 +/- 44 mL), 64 percent of those receiving 100 IU per kg of rHuEPO were able to donate 4 units of blood for autologous use, as compared with 23 percent of the placebo group (p < 0.05). Allogeneic transfusion was avoided, and the preoperative hematocrit and reticulocyte count were significantly higher in the patients receiving 100 IU per kg of rHuEPO (p < 0.05 and p < 0.01, respectively).


CONCLUSIONS
Subcutaneously administered rHuEPO at a dose of 100 IU per kg twice a week for 2 weeks is effective in facilitating the collection of blood for autologous use and may improve the cost-benefit ratio of blood conservation interventions. Doses < or = 60 IU per kg are ineffective in facilitating such collections in this surgical setting.
Sans
T
T
Hospital Mora d'Ebre, Reus, Spain.
Bofil
C
C
Joven
J
J
Clivillé
X
X
Simó
J M
JM
Llobet
X
X
Peró
A
A
Galbany
J
J
D000368:Aged; D001804:Blood Transfusion, Autologous / Q000379:methods*; D004920:Erythropoiesis / Q000187:drug effects; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006400:Hematocrit; D006615:Hip / Q000601:surgery; D006622:Hip Prosthesis; D006801:Humans; D007279:Injections, Subcutaneous; D007717:Knee / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D017701:Reticulocyte Count
D011994:Recombinant Proteins; D004921:Erythropoietin