5d Erythropoietin and iron in autologous haemotherapy

Although current blood supply is safer than ever, allogeneic blood transfusion still involves immunological and infectious risks. The use of allogeneic blood in surgery can be reduced by the introduction of autologous blood (AB) transfusion programmes. Pre-operative blood donation is potentially the most widely used method to obtain AB in elective surgery patients. However, its success is restricted by the patient's ability to donate the required amount of blood that depends on the total red blood cells (RBCs) mass and the capacity of the patient to reconstitute the RBCs collected at each donation. The difficulty in recovering the RBCs collected depends on an inadequate stimulation of endogenous erythropoeitin (EPO) production induced by blood donations. It was suggested that recombinant human EPO (rHuEPO) could be used to stimulate erythropoiesis in pre-depositing patients with the aim of increasing initial Hct levels or accelerating the reconstitution of RBCs lost during collection.

The clinical studies carried out so far in surgical patients showed rHuEPO to be effective in stimulating erythropoiesis, with a consequent increase in the volume of red cells produced during the course of treatment and in the number of units pre-deposited. It was also effective in correcting anaemia induced by collection of blood units. However it emerged that these patients are more prone to develop a ‘functional’ iron-deficiency, because the erythropoiesis increased by rHuEPO, requires abundant iron for Hb synthesis, and storage iron is shifted to Hb. If iron reserves are inadequate or insufficient, the response to rHuEPO is blunted and higher doses of the drug are necessary. Orally administered iron is not sufficient to deliver appropriate amounts of iron for rHuEPO-stimulated erythropoiesis and intravenous supplementation should be adopted to optimize the erythropoietic response to rHuEPO therapy.

It can be concluded that rHuEPO therapy may be safe and effective, in selected patients, in stimulating peri-operative erythropolesis and, consequently, in reducing the exposure to homologous blood. Given the considerable cost of rHuEPO is mandatory to ensure the optimal conditions necessary for the stimulation of erythropoiesis and intravenous iron therapy should be given together with rHuEPO.