[Erythropoietin]

The production of red cells can be stimulated by pharmacologic doses of recombinant human erythropoietin (rHu-EPO), provided EPO-sensitive precursors and iron are available. Its side effects are negligible when used in patients with nonrenal anemia. Antibodies against rHu EPO are a rare event. Iron supplementation is routinely necessary in patients with low iron stores, since availability of iron is a rate-limiting cofactor for red cell production. The rationale for treating patients with anemia of cancer or chronic inflammation is to avoid homologous blood transfusion. However, it is not proven whether a raising of the hemoglobin concentration by 2 or 3 g% will improve the quality of life in these multimorbid patients who undergo palliative treatment. There is no evidence yet that rHu-EPO has reduced morbidity and mortality in such patients. Another question is the cost effectiveness of EPO particularly in patients who suffer from an incurable disease. EPO has also been used as an adjuvant in autologous preoperative transfusion programs and has increased the available volume of red cells for transfusion particularly in conjunction with intravenous iron supplementation. EPO given for 14 days preoperatively in patients with elective hip replacement reduced the need for transfusion by nearly 50%. A high dose of oral ferrous sulfate (300 mg) was given 11 days in advance of rHu EPO. Randomized trials are needed for patients with an initial low Hb (< 13.5 g/dl) to study the efficacy and cost effectiveness of different strategies avoiding homologous transfusion and also the risk-benefit ratio of such strategies versus homologous transfusions, since the risk of homologous transfusions has decreased considerably in recent years.