Toward bloodless surgery: erythropoietin therapy in the surgical setting

Issues related to blood safety and blood inventory have recently led to a much greater interest in blood conservation measures. Some of these measures have included using lower transfusion triggers (hematocrit values), directed donor programs, and autologous blood transfusions. When possible, autologous blood donation is the preferable alternative because it represents the safest blood, conserves blood inventories, and has a salutary effect on physician transfusion behavior. Indeed, homologous blood requirements are lowered in patients who donate autologous blood before elective surgery. However, autologous blood donation can be limited by physician underordering and an insufficient erythropoietic response to serial phlebotomy. Continuing medical education can be effectively used to alter physician behavior regarding underordering. Early clinical trials have suggested that recombinant human erythropoietin (r-HuEPO) can be effectively used to increase the volume of autologous blood obtained before surgery and to prevent the anemia caused by serial phlebotomy. Determining the optimal dose, route, and interval of administration of r-HuEPO is currently the object of ongoing investigations.