Autologous Blood Transfusion in Gastro-intestinal Cancer Operation -The Usefulness of Recombinant Human Erythropoietin (r-HuEPO) in preoperative Blood Donation-

Masahisa Kato, Nobuhiro Wakimoto¹⁾, Kiki Adachi, Tokuyuki Yokohata, Ryouji Fukushima, Mitsuaki Anzai, Kazuko Sakae²⁾, Miyuki Sugiyama²⁾, Kota Okinaga

The Second Department of Surgery, Orthopaedic Surgery¹⁾, Blood Center²⁾, Teikyo University School of Medicine

To evaluate the efficacy and safety of recombinant human erythropoietin (r-HuEPO) for gastrointestinal cancer surgery, we performed preoperative blood donation in 19 patients (7 with gastric cancer, 8 with rectal cancer, 4 with esophageal cancer), who were to undergo elective surgery. These patients were divided into two groups according to their initial hemoglobin concentration. Nine patients with hemoglobin concentrations from 11.0 g/dl to 13.0 g/dl (Group I), donated 800 ml of autologous blood preoperatively with r-HuEPO (24,000 U) administration once a week subcutaneously. Ten patients with hemoglobin concentrations more than 13.0 g/dl (Group II), donated 800 ml of blood without r-HuEPO administration. All the patients were given ferrous sulphate (210 mg of iron) orally every day for three weeks before the operation. There were no significant differences in the background between the two groups except hemoglobin concentration. Theamount of donated autologous blood (755.6±83.1 vs 760.0±120.0),and operative blood loss (780.4±418.7 vs 979.0±247.5) were similar in the two groups. Only one patient in group II required additional homologous blood transfusion. Hemoglobin concentration was significantly (p<0.001) reduced in group II by blood donation, but in group I the hemoglobin concentration did not decrease after donation. The reticulocyte count and serum erythropoietin concentration were significantly (p<0.001, p<0.01) higher in group I; therefore r-HuEPO can accelerated the erythropoietic reaction and red cell production in anemic cancer patients. Iron kinetic examination revealed that a disorder in ferrous sulphate utilization in cancer patients. Serum protein reduction and the prolongation of anticoagulant time (PT, APTT) were observed in both groups, although these changes were not significant. None of the 19 patients showed any adverse effects or abnormal laboratory data attributable tor-HuEPO administration. This study indicates the safety of autologous blood donation in gastrointestinal cancer surgery, and effectiveness of r-HuEPO administration in anemic patients.

Key words
autologous blood transfusion, recombinant human erythropoietin, gastrointestinal cancer surgery

Reprint requests
Masahisa Kato The Second Department of Surgery, Teikyo University School of Medicine
2-11-1, Kaga, Itabashi-ku, Tokyo, 173 JAPAN

Accepted
May 8, 1996

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