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Increased Preoperative Collection of Autologous Blood with Recombinant Human Erythropoietin Therapy

List of authors.
  • Lawrence Tim Goodnough, M.D.,
  • Seth Rudnick, M.D.,
  • Thomas H. Price, M.D.,
  • Samir K. Ballas, M.D.,
  • Myra L. Collins, M.D.,
  • James P. Crowley, M.D.,
  • Martin Kosmin, M.D.,
  • Margot S. Kruskall, M.D.,
  • Bruce A. Lenes, M.D.,
  • Jay E. Menitove, M.D.,
  • Leslie E. Silberstein, M.D.,
  • Kenneth J. Smith, M.D.,
  • Charles H. Wallas, M.D.,
  • Robert Abels, M.D.,
  • and Mark Von Tress, Ph.D.

Abstract

To study whether the administration of recombinant human erythropoietin increases the amount of autologous blood that can be collected before surgery, we conducted a randomized, controlled trial of erythropoietin in 47 adults scheduled for elective orthopedic procedures. The patients received either erythropoietin (600 units per kilogram of body weight) or placebo intravenously twice a week for 21 days, during which time up to 6 units of blood was collected. Patients were excluded from donation when their hematocrit values were less than 34 percent. All patients received iron sulfate (325 mg orally three times daily).

The mean number of units collected per patient (±SE) was 5.4±0.2 for the erythropoietin group and 4.1 ±0.2 for the placebo group. The mean red-cell volume donated by the patients who received erythropoietin was 41 percent greater than that donated by the patients who received placebo (961 vs. 683 ml, P<0.05). Only 1 of the 23 patients treated with erythropoietin was unable to donate ≥4 units(4 percent) as compared with 7 of the 24 patients who received placebo (29 percent). No adverse effects were attributed to erythropoietin.

We conclude that recombinant human erythropoietin increases the ability of patients about to undergo elective surgery to donate autologous blood. (N Engl J Med 1989; 321:1163–8.)

Funding and Disclosures

Supported by R.W. Johnson Pharmaceutical Research Institute, Raritan, N.J. Drs. Goodnough, Price, Collins, Crowley, Kruskall, and Lenes are recipients of Transfusion Medicine Academic Awards from the National Heart, Lung, and Blood Institute of the National Institutes of Health. Dr. Silberstein is the recipient of a grant (DK 39065–01 AI) from the National Institutes of Health.

We are indebted to Dr. Gary Brittenham for his assistance in reviewing the manuscript.

Author Affiliations

From Case Western Reserve University, Cleveland (L.T.G.); R.W. Johnson Pharmaceutical Research Institute, Raritan, N.J. (S.R., R.A., M.V.T.); Puget Sound Blood Center and University of Washington, Seattle (T.H.P.); Cardeza Foundation of Jefferson Medical College, Philadelphia (S.K.B.); University of North Carolina, Chapel Hill (M.L.C.); Brown University, Providence, R.I. (J.P.C.); Robert Wood Johnson University, New Brunswick, N.J. (M.K.); Harvard College, Boston (M.S.K.); American Red Cross, South Florida Region, Miami (B.A.L.); Blood Center of Southeast Wisconsin, Milwaukee (J.E.M.); University of Pennsylvania, Philadelphia (L.E.S.); United Blood Services and University of New Mexico, Albuquerque (K.J.S.); and Vanderbilt University, Nashville (C.H.W.). Address reprint requests to Dr. Goodnough at the Department of Medicine, University Hospitals of Cleveland, 2074 Abington Rd., Cleveland OH 44106.

In accordance with Journal policy, the authors have stated that Drs. Rudnick, Abels, and Von Tress are employees of Johnson & Johnson, parent company of Ortho Pharmaceutical Corporation, and that Dr. Abels is a stockholder in Johnson & Johnson.

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