Avall A, Hyllner M, Bengtson J P, Carlsson L, Bengtsson A
Department of Anesthesia & Intensive Care, East Hospital, Göteborg, Sweden.
Acta Anaesthesiol Scand. 2003 Jul;47(6):687-92. doi: 10.1034/j.1399-6576.2003.00130.x.
Recombinant human erythropoietin in combination with preoperative autologous blood donation is an established regime for avoiding allogenic blood transfusions. The aim of the study was to determine endogenous erythropoietin production and haemoglobin recovery after preoperative autologous blood donation and surgery, with or without recombinant human erythropoietin treatment.
Thirty-eight patients having total hip joint replacement surgery were randomised to receive either autologous blood transfusion (control group) or autologous transfusion plus preoperative recombinant human erythropoietin treatment (EPO group). Haemoglobin, haematocrit, erythropoietin and reticulocyte concentrations were repeatedly analysed, before, during, and after surgery.
No significant differences were found between the groups regarding haemoglobin, haematocrit, and erythropoietin, but the reticulocyte count increased significantly more in the EPO group. There was no difference in the requirement for allogeneic blood transfusions between the groups. The baseline haemoglobin was >13 g dL-1 in all but four patients.
In patients with normal preoperative haemoglobin levels, recombinant human erythropoietin treatment did not improve haemoglobin levels, or reduce the need for allogenic blood transfusion. There were no differences in serum erythropoietin concentrations between the groups. We question whether recombinant human erythropoietin treatment facilitates preoperative autologous blood donation in patients with normal haemoglobin levels.
重组人促红细胞生成素联合术前自体血捐献是一种既定的避免异体输血的方案。本研究的目的是确定术前自体血捐献及手术前后，无论有无重组人促红细胞生成素治疗时内源性促红细胞生成素的产生情况及血红蛋白的恢复情况。
38例行全髋关节置换手术的患者被随机分为接受自体输血（对照组）或自体输血加术前重组人促红细胞生成素治疗（促红细胞生成素组）。在手术前、手术期间和手术后反复分析血红蛋白、血细胞比容、促红细胞生成素和网织红细胞浓度。
两组之间在血红蛋白、血细胞比容和促红细胞生成素方面未发现显著差异，但促红细胞生成素组中网织红细胞计数的增加明显更多。两组之间在异体输血需求方面没有差异。除4名患者外，所有患者的基线血红蛋白均>13 g/dL。
在术前血红蛋白水平正常的患者中，重组人促红细胞生成素治疗并未改善血红蛋白水平，也未减少异体输血的需求。两组之间血清促红细胞生成素浓度没有差异。我们质疑重组人促红细胞生成素治疗是否有助于血红蛋白水平正常的患者进行术前自体血捐献。
