Abstract
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 11.0g/dl to 13.0g/dl (Group I), donated 800ml of autologous blood preoperatively with r-HuEPO (24, 000 U) administration once a week subcutaneously. Ten patients with hemoglobin concentrations more than 13.0g/dl (Group II), donated 800ml of blood without r-HuEPO administration. All the patients were given ferrous sulphate (210mg 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. The amount 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 to r-HuEPO administration. This study indicates the safety of autologous blood donation in gastrointestinal cancer surgery, and effectiveness of r-HuEPO administration in anemic patients.
