A prospective randomized comparison of three blood conservation strategies for radical prostatectomy

Background: Preoperative autologous blood donation is a standard of care for elective surgical procedures requiring transfusion. The authors evaluated the efficacy of alternative blood-conservation strategies including preoperative recombinant human erythropoietin (rHuEPO) therapy and acute normovolemic hemodilution (ANH) in radical retropubic prostatectomy patients. Methods: Seventy-nine patients were prospectively randomized to preoperative autologous donation (3 U autologous blood); rHuEPO plus NH (preoperative subcutaneous administration of 600 U/kg rHuEPO at 21 and 14 days before surgery and 300 U/kg on day of surgery followed by ANH in the operating room); or NH (blinded, placebo injections per the rHuEPO regimen listed previously). Transfusion outcomes, perioperative hematocrit levels, postoperative outcomes, and blood-conservation costs were compared among the three groups. Results: Baseline hematocrit levels were similar in all groups (43% ± 2%). On the day of surgery hematocrit decreased to 34% ± 4% in the preoperative autologous donation group (P < 0.001), increased to 47% ± 2% in the rHuEPO plus ANH group (P < 0.001), and remained unchanged at 43% ± 2% in the ANH group. Allogeneic blood exposure was similar in all groups. The rHuEPO plus ANH group had significantly higher hematocrit levels compared with the other groups throughout the hospitalization (P < 0.001). Average transfusion costs were significantly lower for ANH ($194 ± $192) compared with preoperative autologous donation ($690 ± $128; P < 0.001) or rHuEPO plus NH ($1,393 ± $204, P < 0.001). Conclusions: All three blood- conservation strategies resulted in similar allogeneic blood exposure rates, but ANH was the least costly technique. Preoperative rHuEPO plus ANH prevented postoperative anemia but resulted in the highest transfusion costs.