The effect of recombinant human erythropoietin on the efficacy of autologous blood donation in patients with low hematocrits: A multicenter, randomized, double-blind, controlled trial

Background: This randomized controlled study was undertaken to determine the effect of recombinant human erythropoietin (rHuEPO) on erythropoiesis, autologous blood collection, and allogeneic transfusion risk in elective surgery patients with low baseline hematocrits. Study Design and Methods: Patients (n = 204) with low baseline hematocrits (less than or equal to 39%), scheduled for orthopedic surgery within 25 to 35 days, were seen every 3 to 4 days for 21 days, At each visit, 450 mt of blood was collected if the hematocrit was greater than or equal to 33 percent, and rHuEPO (600 U/kg) or placebo was administered intravenously. Results: One hundred seventy-three patients were evaluable. The number of autologous units collected from the rHuEPO and control groups, respectively, was 4.5 +/- 1.0 and 3.0 +/- 1.1 (p < 0.001), and marrow production of red cells increased by 668 +/- 222 and 353 +/- 155 mL over and above baseline production (p < 0.05). Allogeneic blood transfusion was required by 31 percent of control and 20 percent of rHuEPO patients (p = 0.09), Excluding 8 patients who received >6 units, 29 percent of control and 14 percent of rHuEPO patients required allogeneic blood (p = 0.015). Logistic regression modeling determined that the risk of allogeneic transfusion was reduced by rHuEPO (p = 0.025). Conclusion: The use of rHuEPO stimulates erythropoiesis, permits the storage of more autologous blood, and reduces allogeneic transfusion risk in patients with low hematocrits who are undergoing elective orthopedic surgery. Additional studies are necessary to determine the optimal schedules of rHuEPO administration and autologous blood collection as well as the cost-effectiveness of this strategy.