The effects of recombinant human erythropoietin on autologous blood donation in rheumatoid arthritis patients with anaemia

H. Matsui, N. Shiraishi, T. Yasuda, T. Nezuka

Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Faculty of Medicine, Toyama, Japan


Abstract
Objectives
The effect of recombinant human erythropoietin (rHuEPO) treatment on autologous blood donation was evaluated in anaemic patients with rheumatoid arthritis (RA) undergoing total joint replacement surgery.

Methods
A total of 56 total knee or hip joint replacement operations were performed in the knee or hip joint in 36 anaemic RA patients (hemoglobin (Hb) concentration < 11.0 g/dl). All of the patients received intravenous rHuEPO at a dose of 100 200 units/kg body weight three times a week for 3 weeks. An autologous blood donation of 800 1200 g was the goal for each patient. A refractory case was defined as a patient whose Hb level did not increase to 10.0 g/dl after 3 weeks of treatment with rHuEPO. The objective signs of arthritis were assessed by the Lansbury activity index (AI). During the treatment period, the patients underwent weekly hematological analyses, including routine hematology, serum iron, serum ferritin, C-reactive protein (CRP), and serum erythropoietin levels.

Results
The response to rHuEPO treatment was determined, and blood donation was possible in 47 of 56 joint replacements. In the other 9 operations, donation was not possible due to a poor response to rHuEPO. The mean Hb level before treatment in the refractory group (8.3 g/dl) was significantly lower than that in the responsive group (10.4 g/dl, p = 0.0002). During the treatment period, the mean erythropoietin level was above the normal limit in the refractory group. The mean AI for the refractory group tended to be lower than that in the responsive group. The mean pre-treatment CRP (6.4 mg/dl) and erythrocyte sedimentation rate (ESR) (87.1 mm/h) levels in the refractory group were significantly higher than those in the responsive group (CRP: 3.2 mg/dl, p = 0.008, ESR: 52.6 mm/h, p = 0.01).

Conclusions
The control of disease activity prior to rHuEPO treatment is considered to a prerequisite for autologous blood donation. In addition, severe anaemia (Hb concentration < 8.0 g/dl) appears to be another risk factor for refractoriness to rHuEPO treatment with the present protocol. A higher rHuEPO dose (> 200 units/kg/3 times a week for three weeks) was considered to be necessary in the refractory group.

Key words
Erythropoietin, autologous blood storage, rheumatoid arthritis, artificial arthroplasty.

Please address correspondence and reprint requests to: Dr. Hisao Matsui, M.D., Department of Orthopaedic Surgery, Takaoka City Hospital, 4-1 Takaramachi, Takaoka City, Toyama 933-8550, Japan.

Received on January 26, 1998; accepted in revised form on September 16, 1998.

Clinical and Experimental Rheumatology 1999; 17: 69-74.
© Copyright Clinical and Experimental Rheumatology 1999.