Autologous blood transfusion with recombinant erythropoietin treatment: 22 arthroplasties for rheumatoid arthritis

Abstract

12 anemic and 10 non-anemic patients with rheumatoid arthritis were treated with recombinant human erythropoietin (rHuEPO) before arthroplasty. The patients received 400-800 units/kg of rHuEPO subcutaneously once a week. Autologous blood was collected after the hemoglobin concentration was increased by 5 percent or more. All but one of the patients responded to the treatment. They were given 1-3 units of autologous blood, and underwent the operation without homologous blood transfusion. The mean duration of the treatment was 1 month. In 1 patient with severe anemia, additional transfusion with 2 units of blood was necessary during the operation. In all patients, there was a tendency for the hemoglobin response ratio to rHuEPO to correlate negatively with the initial CRP levels. The treatment did not affect the patients' clinical rheumatologic condition and there were no adverse effects. These results demonstrated that the treatment with subcutaneous rHuEPO is both effective and non-toxic and can therefore eliminate the need for homologous blood transfusion in anemic patients undergoing arthroplasty for rheumatoid arthritis.

Transfusion‐free Surgery is a Treatment Plan for All Patients

“…Recombinant human erythropoietin plays a role in patients undergoing orthopedic procedures 22 . Erythropoietin alfa increases red blood cell mass when used in weekly doses of 600 U/kg or daily doses of 300 U/kg.…”

Erythropoietin administration for preoperative autologous blood donation from patients scheduled for orthopedic surgery

“…Storage of autologous blood prior to orthopedic surgery and for use in postoperative transfusions is on the increase [4,6]; however, this is not feasible for severely anemic patients (Hb below 10.9 g/ml). In Japan, some patients who undergo orthopedic surgery [1,3,7] have a Hb level below 9.9 g/dl on admission to the hospital and they may also have active rheumatoid arthritis (RA), iron deficiency anemia, malnutrition and other bone marrow insufficiencies, and be old.…”