Try Nontraditional Strategies As Alternatives to Blood Transfusions. (Consider Human Erythropoietin).

ORLANDO, FLA. -- A number of nontraditional techniques can help patients avoid blood transfusions, said Dr. Arnold Friedman, chairman of obstetrics and gynecology at Beth Israel Medical Center in Manhattan.

He outlined some of these methods at a meeting of the One Kilo Club, held in conjunction with the 37th International College of Surgeons' North American Federation Congress:

* Prescribe recombinant human erythropoietin. This product, manufactured by Amgen Inc., can be used to correct chronic anemia in patients such a those with large fibroid uteruses. It can also be used to hyperstimulate the production of red blood cells in patients scheduled for surgery who have normal hemoglobin levels but are expected to lose a significant amount of blood, or who do not want to receive transfusions.

Several protocols exist for giving erythropoietin each week following autologous blood donations to normalize a patient's hemoglobin.

"In fact, there is some science in the literature that shows there is a relative deficiency in erythropoietin for about 4 days following surgery, related somehow to the stress of surgery," he said.

* Add iron. The success of erythropoietin therapy depends on an adequate amount of transferrinbound iron, so adjunctive iron is usually given orally, if there's time, or parenterally.

Hematologists, he noted, are often fearful of the notion of using parenteral iron, which has gotten a bad name because it carries a 0.7% risk of anaphylaxis in vulnerable patients. However, he said that after a test dose to rule out allergy a 100-mg dose can be given intravenously. Even large doses can be given over hours.