Preoperative use of erythropoietin (rH-EPO) and determination of optimal doses in patients with BPH for future autologous blood transfusion

Abstract

(Background) Recently, autologous blood transfusion has been widely endorsed, because of the adverse effects attributed to homologous blood transfusion. We found that the administration of recombinant human erythropoietin (rH-EPO) permitted the preoperative collection of an adequate volume of autologous blood in a short period of time. This reduced or eliminated the need for homologous blood transfusion. (Methods) To determine optimal dosage of rH-EPO, I conducted a randomized, controlled trial in 86 patients with benign prostatic hypertrophy (BPH) scheduled for transurethral resection of the prostate (TUR-P). The patients from whom approximately 10% of their total blood volume was removed, received six different doses of rH- EPO either intravenously or subcutaneously. All patients received iron sulfate 100 mg orally once a day during the study. (Results) I found that 9.000 IU of rH-EPO given intravenously daily or 10.500 IU of rH-EPO injected subcutaneously every third day for a week were optimal dosages. These schedules enabled us to withdraw approximately 400 ml of blood prior to operation without adverse effects. (Conclusion) I conclude that the efficacy of rH-EPO is greater when administered subcutaneously rather than intravenously. It is clear that rH-EPO increases the ability of patients about to undergo selective surgery to donate greater amounts of blood for future autologous transfusion.