Erythropoietin in Cancer Surgery

SUMMARY Patients with gastrointestinal cancer usually have a sideropenic anemia unresponsive to iron supplementation which is characterized by low levels of endogenous erythropoietin. Anemic patients are not suitable for preoperative autologous blood donation programs and are at high risk for perioperative homologous blood transfusions. Preoperative treatment with recombinant human erythropoietin (r-HuEPO) has allowed anemic patients to donate autologous blood and reduced homologous blood transfusion after surgery. A dose-response study showed that 400 U/kg of r-HuEPO, divided in four doses administered every four days, is the minimum effective dose which increases hemoglobin levels about 10 g/L/week. The red blood cell (RBC) gain was 268 ± 79 mL, which is grossly equivalent to the RBC content of two units of predonated autologous blood. The total charge for this treatment ($280) was substantially lower than in other experiences in which higher doses of r-HuEPO were given. To maximize erythropoietic response, it is necessary to provide supplementary IV iron (125 mg daily). This results in a normalization of circulating and stored iron, suggesting that the amount was adequate both to sustain the production of new RBCs and to replace tissue stores during r-HuEPO treatment.