Enhanced efficacy of autologous blood donation with epoetin alfa

In the setting of elective orthopedic surgery, epoetin alfa has been shown to facilitate autologous blood (AB) donation and reduce allogeneic blood requirements. However, the most appropriate dose and route of administration remains to be defined. A randomized, double-blind, placebo-controlled study was therefore conducted to compare the effect of different subcutaneous (s.c.) doses of epoetin alfa on hemoglobin (Hb) and endogenous erythropoietin (EPO) levels and transfusion requirements in 62 patients donating AB prior to hip surgery. Epoetin alfa (100 or 200 IU/kg s.c. on days -30, -23, -16, and -9 prior to surgery, in conjunction with oral iron supplementation) dose-dependently ameliorated the reduction in Hb levels associated with AB donation. No patient treated with epoetin alfa required allogeneic blood compared with two placebo recipients (one of whom required additional blood because of reoperation). The results of this study confirm that relatively low dosages of epoetin alfa minimize the decrease in Hb levels during AB donation and help to reduce exposure to allogeneic blood in patients scheduled for elective orthopedic surgery.