Comparison between intravenous and subcutaneous recombinant human erythropoietin (Epoetin alfa) administration in presurgical autologous blood donation in anemic rheumatoid arthritis patients undergoing major orthopedic surgery.
OBJECTIVE
Intravenous (i.v.) Recombinant erythropoietin (Epoetin alfa) is effective in allowing autologous blood donation in patients unable to donate because of anemia. We undertook this open pilot study in order to asses whether a low subcutaneous (s.c.) dose of Epoetin alfa would prove as effective and well tolerated as the higher i.v. dose. Such a move would also decrease costs.


METHODS
A total Epoetin alfa s.c. dose of 800 IU/kg was compared with a total i.v. dose of 1,800 IU/kg. Twenty-two rheumatoid arthritis patients, unable to donate because of hemoglobin (Hb) < 11 g/dl, received 300 IU/kg of IV Epoetin alfa twice weekly for 3 weeks (11 patients), or 100 IU/kg of s.c. Epoetin alfa twice weekly for 3 weeks plus an i.v. bolus of 200 IU/kg of Epoetin alfa at the first visit (11 patients). At each visit, all patients received 100 mg of i.v. iron saccharate and when the hematocrit (hct) > or = 34%, 350 ml of autologous blood (AB) were collected.


RESULTS
No significant differences were observed between the 2 groups of treated patients in terms of units of AB collected (2.6 +/- 0.6 vs. 2.5 +/- 0.5 units for i.v. and s.c. groups, respectively), ml of RBC produced during the study period (291 +/- 99 vs. 337 +/- 65 ml for the i.v. and s.c. groups, respectively), or in the degree of reduced exposure to allogeneic blood in comparison with the control group.


CONCLUSIONS
Lower dose of Epoetin alfa (reduced by 56%), supplemented by i.v. iron, is as effective and well tolerated as higher doses administered i.v., supplemented by i.v. iron.
Mercuriali
F
F
Istituto Ortopedico Gaetano Pini, Milano, Italia.
Inghilleri
G
G
Biffi
E
E
Colotti
M T
MT
Vinci
A
A
Sinigaglia
L
L
Gualtieri
G
G
D000328:Adult; D000368:Aged; D000740:Anemia / Q000150:complications*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery*; D001782:Blood Donors; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011994:Recombinant Proteins / Q000008:administration & dosage
D011994:Recombinant Proteins; D004921:Erythropoietin