Tryba M
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Bergmannsheil Bochum, Germany.
Semin Hematol. 1996 Apr;33(2 Suppl 2):22-4; discussion 25-6.
A low predonation hematocrit (Hct) can preclude the collection of sufficient autologous blood (AB) to meet the transfusion requirements of patients scheduled for orthopedic surgery. Subcutaneous (s.c.) administration of epoetin alfa, in conjunction with intravenous (i.v.) iron supplementation, has proved effective for the facilitation of AB donation by such patients. Compared with untreated controls and patients treated with i.v. iron alone, epoetin alfa 50 to 150 IU/kg SC plus i.v. iron twice weekly for 3 weeks prior to surgery significantly increased total red blood cell (RBC) production (P < .01) and the volume of RBCs donated (P < .05). Epoetin alfa was particularly effective in females and patients with a predicted blood volume (PBV) less than 5 L. Treatment with epoetin alfa led to an increase (albeit nonsignificant) in the number of AB units predonated compared with i.v. iron alone. However, in patients with a PBV less than 5 L, a substantially greater percentage of epoetin alfa-treated patients donated > or = 4 AB units (80% v 30%). Allogeneic blood requirements were reduced, albeit not significantly (P = .051), in patients treated with epoetin alfa. However, in comparison with untreated controls, there was a significant reduction in the mean volume of allogeneic blood transfused per transfused patient in the epoetin alfa groups. The optimum s.c. dose of epoetin alfa in patients with a low predonation Hct scheduled for orthopedic surgery appears to be between 100 and 150 IU/kg twice weekly for 3 weeks.
低预存血红细胞压积（Hct）可能会妨碍采集足够的自体血（AB）以满足计划进行骨科手术患者的输血需求。皮下（s.c.）注射促红细胞生成素α，联合静脉内（i.v.）补充铁剂，已被证明对促进此类患者的AB献血有效。与未治疗的对照组和仅接受静脉内铁剂治疗的患者相比，在手术前3周每周两次皮下注射促红细胞生成素α 50至150 IU/kg加静脉内铁剂，可显著增加总红细胞（RBC）生成（P <.01）和所献RBC的量（P <.05）。促红细胞生成素α在女性和预计血容量（PBV）小于5 L的患者中尤其有效。与仅静脉内铁剂治疗相比，促红细胞生成素α治疗使预存AB单位数量增加（尽管不显著）。然而，在PBV小于5 L的患者中，接受促红细胞生成素α治疗的患者中捐献≥4个AB单位的比例显著更高（80%对30%）。接受促红细胞生成素α治疗的患者异体血需求量有所减少，尽管不显著（P =.051）。然而，与未治疗的对照组相比，促红细胞生成素α组中每位输血患者的异体血平均输血量显著减少。对于计划进行骨科手术且预存血Hct较低的患者，促红细胞生成素α的最佳皮下剂量似乎是每周两次，每次100至150 IU/kg，共3周。
