To study whether the administration of recombinant human erythropoietin increases the amount of autologous blood that can be collected before surgery, we conducted a randomized, controlled trial of erythropoietin in 47 adults scheduled for elective orthopedic procedures. The patients received either erythropoietin (600 units per kilogram of body weight) or placebo intravenously twice a week for 21 days, during which time up to 6 units of blood was collected. Patients were excluded from donation when their hematocrit values were less than 34 percent. All patients received iron sulfate (325 mg orally three times daily). The mean number of units collected per patient (+/- SE) was 5.4 +/- 0.2 for the erythropoietin group and 4.1 +/- 0.2 for the placebo group. The mean red-cell volume donated by the patients who received erythropoietin was 41 percent greater than that donated by the patients who received placebo (961 vs. 683 ml, P less than 0.05). Only 1 of the 23 patients treated with erythropoietin was unable to donate greater than or equal to 4 units (4 percent) as compared with 7 of the 24 patients who received placebo (29 percent). No adverse effects were attributed to erythropoietin. We conclude that recombinant human erythropoietin increases the ability of patients about to undergo elective surgery to donate autologous blood.

Febrile reactions to platelet transfusions are a common problem. The platelet transfusion records from a 30-month period were analyzed to determine 1) when reactions occur in a transfusion sequence; 2) how frequently they recur; and 3) whether the choice of multiple-donor (pooled concentrates) or single-donor components (unmatched apheresis and HLA-compatible apheresis platelets) affected the reaction rate. Overall, 18.7 percent of all patients receiving platelets experienced reactions. A subset of 85 patients, who began platelet support with unmodified components during the study interval, were analyzed in detail. This group received 1204 unmodified transfusions (mean, 14.2/patient), which were associated with 171 reactions (per-transfusion reaction rate, 14.2%). Despite a higher mean white cell content, the transfusion of 438 unmatched single-donor platelets (10.84 x 10(8) white cells, 8.4% reaction rate) resulted in reactions significantly less often than did that of 583 pooled concentrates (8.53 x 10(8) white cells, 21.4% reaction rate) (p less than 0.001). The rate of reaction to HLA-compatible platelets (9/183 transfusions, 4.9%) was not significantly different from that to unmatched single-donor platelets. The use of platelet components from one donor, as opposed to multiple donors, may provide an effective means of reducing the incidence of febrile reactions.

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