The Effect of Patient Size and Dose of Recombinant Human Erythropoietin Therapy on Red Blood Cell Volume Expansion in Autologous Blood Donors for Elective Orthopedic Operation

Abstract

Comment: Autologous blood collection has been an increasingly popular way of minimizing allogeneic blood use in surgical patients. Recombinant human erythropoietin therapy is an effective way of maximizing blood unit collection in a short preoperative time. The cost of EPO therapy has precluded its widespread use, and this article goes some way toward a rational basis for cost-effective therapy. The dose-response relationship is clearly demonstrated, and this can be used to estimate preoperative red cell volume expansion according to body weight. The cost of therapy given in the example, i.e. $1050, remains far in excess of comparable amounts of allogeneic blood, although this does not take into account the cost of any complications that may result from bank blood transfusion or EPO therapy. The fact that the placebo group did not require allogeneic blood suggests that it is not necessary to use EPO in all preoperative blood donors. The authors seem to be suggesting that a subgroup of patients, e.g., those with preoperative anemia, may be identified as the maximal cost-benefit group for EPO therapy. This analysis provides one method of evaluating EPO therapy in terms of cost-effective use in preoperative blood donors.