Epoetin alpha in elective coronary and valve surgery in Jehovah's Witnesses patients. Experience in 45 patients.
BACKGROUND
The religious beliefs of Jehovah's Witnesses who refuse homologous and autologous blood transfusion poses serious problems for surgeons when operating on patients requiring a mean transfusion requirement of =/>2 units of blood.


METHODS
After a number of encouraging studies in a randomised sample of patients 2-3 and after the treatment of some Jehovah's Witnesses 1, a group of 45 patients (23 females and 22 males) underwent elective heart surgery between June 1998 and December 2000. The patients, who were all Jehovah's Witnesses, received pre-treatment with epoetin alpha and ferrous sulphate. In the light of recent studies, it was also decided to repeat medullary preconditioning using the same intervals but with a higher dose. The patients underwent surgery involving myocardial revascularisation, mitral and/or aortic valve replacement, associated interventions, valvuloplasty and ascending aortic aneurysms. After obtaining informed and signed consent, the treatment protocol comprised the administration of 140 IU/kg epoetin alpha three times a week for 3 weeks associated with oral ferrous sulphate 3 times a day. Hematochemical levels (hemoglobin, free hemoglobin, hematocrit, ferritin, transferrin, haptoglobin, reticulocytes, iron levels) were monitored from admission to Day Hospital to discharge.


RESULTS
No patient in the study required blood transfusion.


CONCLUSIONS
The short, medium and long-term follow-up reconfirmed the substantial reliability of this drug linked to the absence of collateral effects.
Podestà
A
A
Cattedra di Cardiochirurgia, Università degli Studi, Genova, Italy.
Parodi
E
E
Dottori
V
V
Crivellari
R
R
Passerone
G C
GC
D000284:Administration, Oral; D000368:Aged; D000747:Anemia, Hypochromic / Q000188:drug therapy / Q000517:prevention & control*; D001803:Blood Transfusion; D002835:Christianity; D001026:Coronary Artery Bypass / Q000379:methods*; D017558:Elective Surgical Procedures; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006351:Heart Valves / Q000601:surgery*; D006397:Hematinics / Q000627:therapeutic use*; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012068:Religion and Medicine; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
D005296:Ferrous Compounds; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; C020748:ferrous sulfate; D000068817:Epoetin Alfa