Comparison of intravenous and subcutaneous erythropoietin therapy for preoperative acquisition of blood for autologous transfusion in patients undergoing total arthroplasty

Before undergoing total arthroplasty, 120 patients agreed to provide their own blood for autologous transfusion. Recombinant human erythropoietin (EPO) was given intravenously to 30 patients (group I), and subcutaneously to 40 (group S); 50 patients (group N) were not given EPO. Fifteen of the 120 patients (group I,n=3; group S,n=3; group N,n=9) required homologous blood transfusion because their hemoglobin levels fell below 7.0g/dl or their vital signs changed after surgery. The hemoglobin recovery rates (HRRs) of groups I, S, and N increased by 22.8%, 47.2%, and 11.8% respectively, compared to estimated hemoglobin rates. The HRRs per 10000 IU EPO increased by 4.7% and 3.6%, respectively, in groups S and I. Groups I and S lost less blood, in total, during and after surgery than group N. Five of the 70 patients in groups I and S combined did not respond to EPO, but no patients treated with EPO experienced any side effects prior to the surgery. During the trial, one woman, who underwent total hip arthroplasty, developed a pulmonary embolism on the 10th postoperative day. Platelet counts and plasminogen activator inhibitor-1 antigen levels in all groups increased after blood donation, with values in the EPO-treated groups being higher than those in group N. Treatment with EPO makes more feasible the donation of their own blood for autologous transfusion in patients about to undergo total arthroplasty.