Preoperative autologous donation of 6 units of blood during rh-EPO treatment

Purpose: To determine if donation of six units of blood in three weeks is possible with self-administered subcutaneous recombinant human erythropoietin (rhEPO) injections and oral iron treatment, Methods: A prospective trial where a total of 32 otherwise healthy patients were phlebotomised before revision hip arthroplasty during rhEPO and oral iron treatment (ferrofumarate). Adverse events were noted and compliance was controlled. Routine laboratory tests were performed at each visit including reticulocytes and 2,3-DPG, The relative oxygen releasing capacity (RORC) and the oxygen releasing capacity (ORC) were calculated, Blood donation was postponed until the next visit if haemoglobin concentrations was <115 g.l(-1) (men) or <105 g.l(-1) (women), Results: All but two patients were able to donate six units of blood with an acceptable haemoglobin concentration on the day of operation, One serious adverse event occurred when the Hb was 119 g.l(-1), compared with 149 g.l(-1) before treatment, During the first two weeks before phlebotomy there was no increase in Hb, the mean nadir was reached after six phlebotomies (31 g.l(-1) below pre-study level), while at operation it was 19 g.l(-1) below pre-study level, There was an increase in 2,3-DPG and oxygen releasing capacity after the initiation of rhEPO therapy, before the first phlebotomy, Conclusion: It is possible to donate six units of blood in a three week period before surgery during self-administered subcutaneous rhEPO treatment and oral iron therapy at a rhEPO dose of 60 U.kg(-1) BW three times a week, it is suggested that rhEPO per se initiates a right-shift of the oxygen dissociation curve via an increased 2,3-DPG level, which could explain that some patients report subjective benefit of rhEPO in spite of no change in Hb concentration.