Effects of recombinant human erythropoietin on autologous blood donation before open heart surgery.

We studied the effects of four different doses of recombinant human erythropoietin (rhEPO) on the amount of preoperative autologous blood donation. 43 patients prior to open heart surgery were randomized into 5 groups (100, 200, 400, 800 U/kg rhEPO i.v. or placebo) and treated twice weekly over a period of 4 weeks. Autologous blood was taken at a hemoglobin of 13 g/dl and a hematocrit of 34% respectively. Application of low-dose rhEPO (100 and 200 U/kg) did not increase the amount of autologous blood donated, only 400 and 800 U/kg produced a significant increase by 27% and 39% respectively (p < 0.01) In addition RBC showed a reduced decline of hemoglobin level (p < 0.01). Reticulocytes increased by 2.5 times the baseline in the placebo and treatment groups up to 200 U/kg. Again, only 400 and 800 U/kg produced a significantly higher increase of 3.2 and 3.6 times respectively (p < 0.05 and p < 0.01). Although iron was supplied orally, ferritin levels declined in all groups whereas serum iron and transferrin levels remained unchanged. No influence could be detected on WBC, thrombocyte count, or arterial blood pressure. Mild and reversible side effects were observed in 8 patients (19%). Perioperatively 34 patients (81%) received exclusively autologous blood, only 8 patients (19%) needed additional homologous blood transfusions. Administration of high-dosed rhEPO (400-800 U/kg) seems to be an effective treatment with only slight side effects for increasing erythropoiesis during autologous blood donation.