Response of the erythron and erythropoietin to autologous blood donations in paediatric subjects. Is erythropoietin supplement necessary?

Objectives: This study was undertaken to evaluate the need for erythropoietin (Epo) therapy to augment autologous blood collection in adolescents undergoing spinal corrective surgery. Methods: We measured serum Epo and parameters of iron metabolism in 35 adolescents undergoing autologous blood collection for orthopaedic surgery. Ages of subjects ranged from 11 to 16 years (mean 15.5 years) with a female predominance. Generally, 10% of intravascular blood volume was collected once a week up to a total of three collections. Results: There was an average 2.5-fold rise in serum Epo over the period of blood collection. Epo increased immediately after blood collection. There was a 1.4-fold rise in reticulocyte count, consistent with the Epo response, and an average of 1.5 units of red blood cells (200 ml, unit) being produced over this period, Despite this there was an average fall of 2 g/dl (15%) in haemoglobin level, Serum ferritin and transferrin saturation also fell. Conclusions: Paediatric subjects: are able to donate the required units of blood as they have a good Epo response to mild anaemia. The amount of blood donated did not exceed their total mobilisable iron and the iron supplement was adequate for red cell synthesis.