Abstract
Purpose
To determine if donation of six units of blood in three weeks is possible with self-administered subcutaneous recombinant human erythropoietin (rhEPO) injections and oral iron treatment.
Methods
A prospective trial where a total of 32 otherwise healthy patients were phlebotomised before revision hip arthroplasty during rhEPO and oral iron treatment (ferrofumarate). Adverse events were noted and compliance was controlled. Routine laboratory tests were performed at each visit including reticulocytes and 2,3-DPG. The relative oxygen releasing capacity (RORC) and the oxygen releasing capacity (ORC) were calculated. Blood donation was postponed until the next visit if haemoglobin concentrations was < 115 g·l−1 (men) or < 105 g·l−1 (women).
Results
All but two patients were able to donate six units of blood with an acceptable haemoglobin concentration on the day of operation. One serious adverse event occurred when the Hb was 119 g·l−1, compared with 149 g·l−1 before treatment. During the first two weeks before phlebotomy there was no increase in Hb, the mean nadir was reached after six phlebotomies (31 g·l−1 below pre-study level), while at operation it was 19 g·−1 below pre-study level. There was an increase in 2,3-DPG and oxygen releasing capacity after the initiation of rhEPO therapy, before the first phlebotomy.
Conclusion
It is possible to donate six units of blood in a three week period before surgery during self-administered subcutaneous rhEPO treatment and oral iron therapy at a rhEPO dose of 60 U·kg−1 BW three times a week. It is suggested that rhEPO per se initiates a right-shift of the oxygen dissociation curve via an increased 2,3-DPG level, which could explain that some patients report subjective benefit of rhEPO in spite of no change in Hb concentration.
Résumé
Objectif
Déterminer s’il est possible de prélever six unités de sang en tras semaines avec l’appoint de l’érythropoïétine recombinante humaine (rhEPO) en injections sous-cutanées auto-administrées et de la sidérothérapie orale.
Méthodes
Cette étude prospective regroupait 32 patients bien portants phébotomisés avant une révision d’arthroplastie de la hanche et l’administration orale de fer (ferrofumarate). Les réactions secondaires ont été notées et la compliance contrôlée. Les épreuves de laboratoire usuelles effectuées à chaque visite incluaient le réticulocytose et les 2,3-DPG. La capacité relative de relargage de l’oxygène (RORC) et la capacité de relargage de l’oxygène (ORC) ont été calculées. On reportait le don sanguin jusqu’à la visite suivante si la concentration d’hémoglobine était < 115 g·L−1 (hommes) ou < 105 g·L−1 (femmes).
Résultats
Tous les patients à l’exception de deux ont pu donner six unités de sang tout en maintenant une concentration en hémoglobine acceptable le jour de l’intervention. Une complication grave est survenue quand l’Hb était 119 g·L−1, comparativement à 149 g·L−1 avant traitement. L’hémoglobine n’a pas augmenté pendant les deux premières semaines qui précédaient la phlébotomie et la valeur moyenne la plus basse était atteinte après six phlébotomies (31 g·L−1 sous le niveau antérieur à l’étude), alors qu’au moment de l’intervention l’Hb était 19 g·L−1 sous le niveau antérieur à l’étude. Les 2,3-DPG et la capacité de largage de l’oxygène augmentaient après le début du traitement au rhEPO avant la première phlébotomie.
Conclusion
Il est possible de faire un don de six unités de sang en trois semaines avant la chirurgie pendant l’autoadminsitration sous-cutanée du traitement au rhEPO à la dose de 60 U·kg−1 trois fois par semaine et la sidérothérapie orale. Il est suggéré que per se le rhEPO induit un déplacement vers la droite de la courbe de dissociation de l’hémoglobine par augmentation du niveau des 2,3-DPG, ce qui pourrait expliquer le bienfait subjectif du rhEPO décrit par certains patients malgré l’absence de changements de la concentration de l’hémoglobine.
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Milbrink, J., Birgegård, G., Danersund, A. et al. Preoperative autologous donation of 6 units of blood during rh-EPO treatment. Can J Anaesth 44, 1315–1318 (1997). https://doi.org/10.1007/BF03012783
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DOI: https://doi.org/10.1007/BF03012783