80796
document
[ Erythropoietin therapy during frequent autologous blood donations . Dose-finding study ] . Avoidance of homologous blood products and patients ' demand for preoperative autologous blood donation programs are increasing . As many of these patients are older , with a compromised cardiovascular system and a slow response of the erythropoietic system when anemia occurs , the feasibility and benefit of autologous blood donation is often limited . Augmentation of preoperative blood donation by therapy with recombinant human erythropoietin ( rHuEPO ) has been described in animal models and in patients . METHODS . In a multicenter , controlled , randomized trial , 49 patients scheduled for orthopaedic or vascular surgery received 0 ( control group , n = 9 ) , 200 ( n = 10 ) , 300 ( n = 11 ) , 400 ( n = 10 ) or 500 ( n = 9 ) U/kg rHuEPO ( Erypo , Cilag , Sulzbach , distributor Fresenius , Oberursel , Germany ) subcutaneously twice a week for 3 weeks while every week 450 ml blood was collected . Iron sulphate 100 mg was prescribed orally twice a day . Patients were ineligible if they had uncontrolled hypertension , recent myocardial infarction , haematological disorders or a history of seizures . Blood donation had to be cancelled if the haematocrit was below 30 % . RESULTS . There was a significant ( ANOVA ) drop of the haematocrit value only in the control group , and end-point values for haematocrit and haemoglobin were significantly elevated in the 400 and 500 U/kg groups compared with the control group ( Table 9 ) . DISCUSSION . The erythropoietic stimulus of phlebotomy for autologous blood donations is often not efficient enough to guarantee a constant haematocrit . Lowering of the preoperative haematocrit jeopardizes the aim of avoidance of homologous blood transfusions . rHuEPO increased the efficiency of autologous blood collections , as predonation haematocrit values could be preserved in the high-dosage groups . As a consequence , homologous transfusions could be avoided . However , there were broad interindividual differences in the erythropoietic response , possibly due to limitations in iron availability . Adverse effects of rHuEPO therapy , such as hypertension , thrombosis or neurologic disorders , are mostly reported in patients with terminal kidney failure . No such disturbances were observed in the present study . CONCLUSION . rHuEPO ameliorates the preoperative decrease of haemoglobin and haematocrit values due to autologous blood donations in a dose-related fashion . The individually adjusted dosage of rHuEPO and iron supplementation merits further investigation .
80797
Intervention_Pharmacological
Erythropoietin
80798
Intervention_Pharmacological
recombinant human erythropoietin
80799
Intervention_Pharmacological
rHuEPO
80800
Intervention_Pharmacological
Erypo
80801
Intervention_Pharmacological
Cilag
80802
Intervention_Pharmacological
Sulzbach
80803
Intervention_Pharmacological
distributor Fresenius
80804
Intervention_Pharmacological
Oberursel
80805
Intervention_Pharmacological
Iron sulphate 100 mg
80806
Intervention_Pharmacological
rHuEPO
80807
Outcome_Other
haematocrit value
80808
Outcome_Other
end-point values for haematocrit and haemoglobin
80809
Outcome_Physical
haematocrit
80810
Outcome_Physical
haematocrit
80811
Outcome_Other
efficiency
80812
Outcome_Physical
erythropoietic response
80813
Outcome_Adverse-effects
hypertension
80814
Outcome_Adverse-effects
thrombosis
80815
Outcome_Adverse-effects
neurologic disorders
80816
Outcome_Physical
terminal kidney failure .
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Outcome_Physical
ameliorates
80818
Outcome_Physical
haemoglobin and haematocrit values
80819
Participant_Condition
autologous blood donations
80820
Participant_Age
older
80821
Participant_Condition
compromised cardiovascular system
80822
Participant_Sample-size
49
80823
Participant_Condition
orthopaedic or vascular surgery
80824
Participant_Condition
terminal kidney failure