Erythropoietin levels in patients depositing autologous blood in short intervals

Summary Plasma immunoreactive erythropoietin (EPO) concentrations were studied in ten patients (7 men, 3 women) predonating autologous blood for hip arthroplasty. Donations were scheduled on day 1, 3, 7, 14 (and 21 if four units could not be donated previously). A predonation hemoglobin concentration of 11 g/dl was required. The donations led to a decline of the hemoglobin concentration from 14.1±1.0 g/dl (X±SD) prior to donation to 11.0±0.9 g/dl on day 15. EPO concentration prior to donation was 17.6±2.6 mU/ml. Each phlebotomy was followed by a rise in EPO levels that reached a peak concentration within 1 day. The highest concentration (35.8±15.0 mU/ml) was measured on day 16. The peak concentration was followed by a plateau at lower, although still elevated levels after the first and second donation, and by a slow, continuous decline after the third and fourth donation. This particular time course is similar to that during weekly donations [15]. The time integral of the EPO concentration during the first 3 weeks, however, was greater in the present study. This increased availability of EPO early during donation may lead to a more efficient stimulation of erythropoiesis.     

Sequential treatment of anemia in ulcerative colitis with intravenous iron and erythropoietin.

BACKGROUND: Intravenous iron and erythropoietin have been shown to be effective in Crohn's disease-associated anemia. The aim of this study was to test the sequential treatment of anemia in ulcerative colitis with intravenous iron in the first phase and erythropoietin in the second. PATIENTS AND METHODS: Twenty patients with ulcerative colitis-associated anemia (hemoglobin < or = 10.5 g/dl) entered this open-label trial. In the first phase all patients received intravenous iron saccharate for 8 weeks. A response was defined as an increase in hemoglobin > or = 2.0 g/dl; a final hemoglobin >10.5 g/dl was regarded as full response, < or = 10.5 g/dl as partial response. A hemoglobin increase < 2.0 g/dl was regarded as nonresponse. In the second phase (n = 4) erythropoietin was initiated in patients without response. Patients with partial response were continued on iron saccharate for another 8 weeks. RESULTS: During the first phase the hemoglobin increased from 8.3 to 11.9 g/dl (mean hemoglobin difference 3.6+/-2.3 g/dl, p < 0.001). Fifteen patients (75%) showed a full response (mean hemoglobin difference 4.5+/-1.5 g/dl), 1 (5%) a partial response (hemoglobin difference 2.1 g/dl) and 4 no response (mean hemoglobin difference 0.4+/-1.8 g/dl) with a need for blood transfusions in a single patient. In the second study phase erythropoietin was highly effective in previous nonresponders (mean hemoglobin difference 3.3+/-1.9 g/dl). The single patient with partial response had a minor hemoglobin increase (hemoglobin difference 1.0 g/dl). CONCLUSION: Most patients with ulcerative colitis-associated anemia improve on intravenous iron alone. Erythropoietin is effective in those who do not respond.     

Erythropoietin administration for preoperative autologous blood donation from patients scheduled for orthopedic surgery

Our objectives was to evaluate erythropoietin (EPO) administration for preoperative autologous blood donation from anemic patients scheduled for orthopedic surgery. EPO was administered to 170 patients intravenously (i.v.) and subcutaneously (s.c.). To compare the difference between i.v. and s.c. administration the hemoglobin recovery rates per 10 000 IU of EPO (uHRR) administered i.v. and s.c. were calculated. The i.v. and s.c. uHRR increased by 7.0 and 3.3%, respectively, in patients with admission Hb levels below 9.9 g/dl. The acquisition of scheduled blood was feasible for 54.7% and homologous blood transfusion was not needed for 88.7% of severely anemic patients. Eight patients required homologous blood transfusions and seven showed no response to EPO. We conclude that autologous blood transfusion with EPO treatment for anemic patients is safe and useful.     

Preoperative autologous blood donation in primary total knee arthroplasty: a single-centre experience on 214 consecutive patients

BACKGROUND AND OBJECTIVES: Although preoperative autologous blood donation (PABD) is a widespread practice in elective orthopedic surgery, it is controversial whether this procedure avoids allogeneic blood transfusions in patients undergoing total knee arthroplasty (TKA). PATIENTS AND METHODS: We performed a retrospective study on 214 consecutive patients undergoing PABD before elective primary TKA. RESULTS: Thirty-eight patients (17.8%) were transfused with autologous red blood cells (RBC), while four of them (10.5% of those requiring transfusions, 1.9% of all patients) also received allogeneic RBC. The transfused patients were, in most cases, female and had significantly lower basal and preoperative haemoglobin levels. CONCLUSIONS: Based on the results of this study, PABD is not necessary in most patients undergoing TKA, although older female patients with low basal haemoglobin levels could benefit from a predeposit programme and/or erythropoietin support in order to reduce the risk of exposure to allogeneic blood.     

Erythropoietin administration for preoperative autologous blood donation from patients scheduled for orthopedic surgery

Abstract

Our objectives was to evaluate erythropoietin (EPO) administration for preoperative autologous blood donation from anemic patients scheduled for orthopedic surgery. EPO was administered to 170 patients intravenously (i.v.) and subcutaneously (s.c.). To compare the difference between i.v. and s.c. administration the hemoglobin recovery rates per 10 000 IU of EPO (uHRR) administered i.v. and s.c. were calculated. The i.v. and s.c. uHRR increased by 7.0 and 3.3%, respectively, in patients with admission Hb levels below 9.9 g/dl. The acquisition of scheduled blood was feasible for 54.7% and homologous blood transfusion was not needed for 88.7% of severely anemic patients. Eight patients required homologous blood transfusions and seven showed no response to EPO. We conclude that autologous blood transfusion with EPO treatment for anemic patients is safe and useful.     

Preoperative autologous blood donation for cardiac surgery in children

Preoperative autologous blood donation has been shown to reduce homologous blood transfusion in cardiac operations, but there have been few reports of its use in children. Of 50 children aged 6 months to 5 years (weight, 6.1-14.8 kg) undergoing primary cardiac surgery for simple anomalies, 23 donated autologous blood before surgery, the other 27 were age and weight-matched controls. Two donations of 10 mL x kg(-1) each were collected via the femoral vein under mild general anesthesia 12 +/- 5 and 19 +/- 7 days preoperatively. No complications related to autologous blood collection were observed. Homologous blood use was significantly less in the group given autologous blood (4.3%) compared to the control group (44.4%). There was no significant difference in hemoglobin levels between groups before, during or after the operation. Preoperative autologous blood donation appears to be safe and effective in reducing homologous transfusions, even in children weighing less than 15 kg.     

Prevalence and Classification of Anemia in Elective Orthopedic Surgery Patients: Implications for Blood Conservation Programs

We audited 281 consecutive orthopedic patients scheduled for surgery for whom blood type/cross-matching was requested over a 6-month period. One hundred and sixty-two patients predonated autologous blood at University Hospitals of Cleveland, and 34 (21%) of these were anemic [hematocrit (Hct) less than or equal to 39%] at initial donation. Twelve (35%) of these 34 anemic autologous blood donors subsequently received homologous blood. In contrast, 18 (15%) of 128 nonanemic autologous blood donors received homologous blood (p = 0.05). In 119 patients who did not donate autologous blood, 39 (33%) were anemic at admission. Of these, 22 (56%) received homologous blood. In the 80 remaining nonanemic patients, 33 (41%) received homologous blood (p = 0.119). Analysis of discharge Hct indicates that 31 (12%) of 263 evaluable patients were possibly transfused inappropriately. The anemias of a cohort of 30 autologous donors were analyzed: 5 had rheumatoid arthritis without iron deficiency. Nine (30%) others had evidence of iron deficiency. Sixteen (53%) had an unclassified anemia of chronic disease. We conclude: (1) the high rates of homologous blood exposure indicate a need for innovative blood conservation strategies in anemic autologous blood donors; (2) the prevalence of anemia and the high rates of homologous blood exposure in anemic patients who did not donate autologous blood demonstrate a need for early recognition and treatment in order to procure autologous blood and reduce homologous blood exposure; (3) the presence of inappropriate autologous and homologous transfusions demonstrates a need for more effective physician education programs that emphasize 'no blood transfusion' as an alternative to enhance blood conservation effectiveness.     

The pathogenesis of anemia in rheumatoid arthritis: a clinical and laboratory analysis

Principal concepts concerning the anemia of RA are summarized in Tables 7 and 8. These concepts have been validated by our analysis of 93 anemic RA patients and by our review of the literature. The fact that anemia in RA may have one or more etiologies, occasionally in the same patient, mandates a reasoned approach to the analysis of anemia in every RA patient in whom it may occur. In particular, iron deficiency is common and determination of bone marrow iron content via an aspirate may be required for a definitive diagnosis. In those RA patients with anemia of chronic disease, the best therapy remains control of the underlying disease, most commonly with second line drugs and/or corticosteroids. The place for recombinant erythropoietin in the therapy of this anemia has not been defined; one specific role for erythropoietin may be in the preparation of RA patients for elective surgery, particularly hip arthroplasty, where correction of the anemia may either obviate the need for transfusion or may allow for donation of blood for purposes of autologous transfusion perioperatively. The pathogenesis of the anemia of chronic disease, as seen in RA anemia, is not completely understood. Inflammatory mediators, particularly the cytokines, appear to be important factors in the impairment of erythropoiesis. The mechanism by which these cytokines impair erythroid progenitor growth and hemoglobin production in developing erythrocytes is an important area for future study.     

Anemia in inflammatory bowel disease - the role of recombinant human erythropoietin

Anemia is a common problem in inflammatory bowel disease (IBD). It is related to low Karnofsky scores, loss of weight, impaired physical activity, low tolerance to the underlying disease, and a poor growth rate in children. Multiple factors can contribute to the anemia in IBD, such as iron, folic acid or B(12) deficiency, treatment with immunosuppressive drugs or sulfasalazine, hemolysis, and anemia of chronic disease. Anemia of chronic disease is characterized by impaired iron utilization, lower erythropoietin (EPO) production than needed, and a low response of bone marrow erythroid progenitor cells to EPO. In recent years, recombinant human erythropoietin (rhEPO) has been used in combination with iron for the correction of refractory anemia in IBD patients (adults or children) with good results. There is increasing evidence that rhEPO may correct refractory anemia in IBD (both ulcerative colitis (UC) and Crohn's disease (CD)). In addition, such therapy may give IBD patients the opportunity to predonate blood before surgery and to avoid blood transfusions. One must not forget to exclude or correct other causes of anemia in IBD patients before administering rhEPO. Furthermore, the enhancement of erythropoiesis by EPO makes it mandatory to administer oral or intravenous iron supplementation during therapy to meet the increased demand. rhEPO is safe in IBD patients. Further studies with larger numbers of patients are needed to optimize the therapy with rhEPO in the refractory anemia of IBD.     

Administration of high doses of recombinant human erythropoietin to patients with β-thalassemia intermedia: a preliminary trial

Abstract: Four patients (1 male, 3 female, age range 16–56 yr) with β-thalassemia intermedia were given high doses of recombinant human erythropoietin (rHuEpo), iron sulfate and folic acid in an attempt to improve their anemia. The dose schedule was: rHuEpo, 500 U/kg 3 times weekly, iron sulfate, 300 mg/d and folic acid, 5 mg/d. All patients were red blood cell transfusion-dependent. Hematological data and fetal hemoglobin (HbF) were assayed every 2 wk. XmnI polymorphism and β-thalassemia mutations were identified by PCR. All patients showed a moderate to high increase in hemoglobin values (mean value: 2.5 g/dl) and in 1 patient HbF levels also increased; 3 patients became red blood cell transfusion-independent and 1 patient was able to extend the intervals between transfusions significantly. No side effects were observed during rHuEpo therapy.     

Effectiveness of darbepoetin-alfa in combination with intravenous iron sucrose in patients with inflammatory bowel disease and refractory anaemia: a pilot study

BACKGROUND: The combination of intravenous iron and recombinant human erythropoietin has been proved to be effective in the treatment of refractory anaemia in patients with inflammatory bowel disease (IBD). Darbepoetin-alpha (DPO) has a three-fold longer terminal half-life than erythropoietin. The purpose of this pilot study was to determine whether darbepoetin-alpha is also effective for the treatment of refractory anaemia in IBD. METHODS: Twenty IBD patients (nine ulcerative colitis and 11 Crohn's disease) and refractory anaemia received intravenous iron sucrose (total iron dose 1.3+/-0.5 g, range 0.7-1.9) and darbepoetin-alfa at the single, weekly dose of 0.9 microg/kg subcutaneously for 4 weeks. Serum erythropoietin, ferritin, transferrin, soluble transferrin receptor, C-reactive protein and interleukin-6 were measured at baseline and after treatment. RESULTS: Haematopoietic response (increase of haemoglobin > or = 2.0 g/dl) was observed in 15 out of the 20 patients (75%). The mean haemoglobin concentrations increased from 9.48+/-0.82 g/dl at baseline to 12.71+/-1.12 g/dl after treatment (P<0.0001). Mean corpuscular volume and serum ferritin levels were also significantly increased whereas mean C-reactive protein levels and endogenous erythropoietin levels significantly decreased after treatment. CONCLUSIONS: In IBD patients with refractory anaemia the administration of darbepoetin in combination with intravenous iron sucrose can raise haemoglobin levels.     

Anemia in Crohn's disease

Intestinal blood loss as well as chronic inflammation are regarded as the most important mechanisms in the pathogenesis of anemia in Crohn's disease. In addition, cytokines such as interleukin-6 can suppress erythropoietin production. This study was performed to investigate the importance of iron status, inflammatory activity, and endogenous erythropoietin concentrations for the development of anemia in Crohn's disease. In 49 consecutive patients with Crohn's disease, hemoglobin, inflammatory activity (Crohn's disease activity index, C-reactive protein, α₁-acid glycoprotein), iron status (serum iron, transferrin, transferrin saturation, ferritin), and serum erythropoietin levels were studied. Anemic (Hb<12.0 g/dl;N=16) vs nonanemic patients (Hb≥12 g/dl;N=33) showed reduced iron compartments (eg, ferritin 28.7±12.9 µg/liter vs 63.2±15.0 µg/liter, transferrin saturation 6.2±1.4% vs 11.5±1.3%,P<0.01) but no differences in inflammatory activity. An inverse correlation between erythropoietin and hemoglobin concentrations was found (r=-0.62;P<0.001), but the increase in erythropoietin levels was inadequate to the degree of anemia. There was no correlation between erythropoietin and interleukin-6 serum levels. Four of five anemic patients with hemoglobin below 10.5 g/dl and erythropoietin levels within the normal range were treated with parenteral iron (200 mg iron saccharate in 250 ml NaCl, weekly, intravenously). Two of them additionally received recombinant human erythropoietin (150 units/kg, 3× weekly, subcutaneously). After five weeks all patients had a marked increase in hemoglobin. However, the mean increase in erythropoietin-treated patients was 5.0 g/dl compared to 2.0 g/dl in the patients with iron therapy only. No side effects were seen. Our data demonstrate that inadequate erythropoietin production and iron deficiency are pathogenetic factors of anemia in Crohn's disease. The therapeutic management using recombinant human erythropoietin and parenteral iron is reasonable and effective.     

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

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.     

Recombinant Human Erythropoietin as Adjuvant Treatment for Autologous Blood Donation: A Prospective Study

In a prospective randomized study we investigated the potential of subcutaneous recombinant human erythropoietin (rhEpo) as adjuvant treatment for autologous blood transfusions (3 units) in elective surgery. Four and 2 weeks before surgery, 49 patients received 6 times 10,000 U of rhEpo. ΔHb values (days -28 and 0) of the rhEpo group were compared to ΔHb values of 52 controls (no rhEpo). Reticulocytes were measured at days -21, -14, -7 and 0. Peri- and postoperative supplementary homologous blood requirements were compared in the two randomized groups. ΔHb of rhEpo group was 0.96 g/dl (mean value) and 2.38 for controls. Reticulocyte count increased earlier and to higher levels in rhEpo-treated patients. Except in 1 case, Epo was well tolerated. These results indicate that autologous predonation (3 times 400 ml) does not create anemia if adjuvant Epo treatment is given. However, homologous blood requirements were not significantly different, which is probably due to the fact that 96 of the 101 treated patients underwent elective orthopedic surgery requiring limited blood replacement. Significant benefit of the Epo regimen can be expected in elective cardiovascular and hepatic surgery where larger amounts of blood (5–6 units) are needed.     

Stimulating erythropoiesis in inflammatory bowel disease associated anemia

Anemia is a frequent complication in patients with inflammatory bowel disease (IBD), and is associated with decreased quality of life and increased rate of hospitalization. The primary therapeutic targets of IBD- associated anemia are iron deficiency and anemia of chronic disease. An important prognostic parameter of the success or failure of therapy is the outcome of the underlying disease. Iron deficiency should be appropriately managed with iron supplementation. However, the use of oral iron therapy is limited by several problems, the most important being gastrointestinal side effects leading occasionally to disease relapse and poor iron absorption. Intravenous iron preparations are more reliable, with iron sucrose demonstrating the best efficacy and tolerability. Treatment with erythropoietin or darbepoetin has been proven to be effective in patients with anemia, who fail to respond to intravenous iron. Patients with ongoing inflammation have anemia of chronic disease and may require combination therapy comprising of intravenous iron sucrose and erythropoietin. After initiating treatment, careful monitoring of hemoglobin levels and iron parameters is needed in order to avoid recurrence of anemia. In conclusion, anemia in the setting of IBD should be aggressively diagnosed, investigated, and treated. Future studies should define the optimal dose and schedule of intravenous iron supplementation and appropriate erythropoietin therapy in these patients.     

Prediction of response to iron sucrose in inflammatory bowel disease-associated anemia

OBJECTIVE: Inflammatory bowel disease (IBD)-associated anemia responds to i.v. iron therapy. However, because of concurrent chronic inflammation, some patients do not respond adequately. Erythropoietin therapy has been shown to be effective in the latter cohort. Our goal was to find parameters that can predict the effectiveness of iron sucrose in IBD-associated anemia. METHODS: One hundred three patients with severe IBD-associated anemia (Hb < or = 10.5 g/dl) were treated prospectively for 4 wk with iron sucrose (total iron dose = 1.2 g) in an open label, multicenter trial. Treatment response was defined as an increase in Hb of > or =2.0 g/dl. A logistic regression analysis was performed with treatment response as the dependent variable and the following independent variables: serum erythropoietin, mean corpuscular Hb, transferrin, ferritin, soluble transferrin receptor (sTfR), C-reactive protein, interleukin 6 (IL-6), and disease activity. RESULTS: Sixty-seven of 103 patients (65%) responded to iron sucrose. From the variables under investigation, erythropoietin, sTfR, transferrin, and IL-6 were significantly associated with treatment response. The R2 values showed that erythropoietin (8.0%), sTfR (11.4%), and transferrin (10.4%), but not IL-6 (1.3%), contribute a relevant amount of information to the model. An estimated 80% probability of treatment response was found at erythropoietin levels of >166 U/L, sTfR levels of >75 nmol/L, or transferrin levels of >3.83 g/L. CONCLUSIONS: Serum erythropoietin, sTfR, and transferrin concentrations have the potential to predict the response to iron sucrose therapy in IBD-associated anemia. These parameters may help to identify individuals who benefit the most from additional erythropoietin treatment.     

Autologous Blood Donation Preceding Coronary Artery Bypass Graft Operation in a Hemodialysis Patient

Abstract: A 67-year-old male hemodialysis patient with abdominal aortic aneurysm and triple vessel coronary heart disease required autologous blood donation because of his blood type of Rh(-) before cardiovascular surgery. We performed autologous red blood cell and plasma collection by the switch back method with recombinant human erythropoietin therapy during the 5 weeks before the operation. Autologous platelet collection was also made the day before the operation. These autologous blood donations were safely and successfully performed along with hemodialysis. There was some caution taken for these pro cedures. The ultrafiltration rate had to be adjusted for blood collection or blood transfusion during hemodialysis in order not to disturb fluid balance. It was necessary to monitor the hyperkalemia of the stored autologous packed red blood cells. For platelet collection, blood in the extracorporeal circuit had to be concentrated because of the presence of renal anemia. Coronary artery bypass graft was safely and successfully performed with the autologous blood only.     

Common misconceptions in the diagnosis and management of anemia in inflammatory bowel disease

Anemia is the most common systemic complication of inflammatory bowel disease (IBD); so common that it is almost invariably not investigated and rarely treated. Several misconceptions are the reason for these clinical errors, and our goal will be to review them. The most common misconceptions are: anemia is uncommon in IBD; iron deficiency is also uncommon; just by treating the intestinal disease, anemia will be corrected; iron deficiency is the only cause for anemia in IBD; ferritin is an accurate parameter for the diagnosis of iron deficiency in IBD; the impact of anemia on the quality of life of IBD patients is limited; iron supplementation is rarely needed in IBD; high-dose oral iron solves the problem of iron malabsorption in IBD; intravenous (IV) iron is dangerous and of no proven benefit in IBD; IV iron is useful only for severe anemia; and erythropoietin has no role in the treatment of IBD anemia. These misconceptions are not evidence-based. On the contrary, there is enough evidence to support the following statements: (a) anemia is very common in IBD, (b) anemia should be investigated with care because many factors can be responsible, (c) treatment of anemia results in clear improvement in the objective parameters of well-being, especially in the quality of life, (d) IV iron is safe and effective in the treatment of iron deficiency anemia in IBD patients, and (e) erythropoietin is useful in a subset of patients with refractory anemia. Anemia diagnosis and treatment must not be neglected in IBD patients, and several misconceptions should be promptly abandoned.     

Comparison between Intravenous and Subcutaneous Recombinant Human Erythropoietin (Epoetin Alfa) Administration in Presurgical Autologous Blood Donation in Anemic Rheumatoid Arthritis Patients Undergoing Major Orthopedic Surgery

Background and objectives: Intravenous (i.v.) Recombinant erythropoietin (Epoetin alfa) is effective in allowing autologous blood donation in patients unable to donate because of anemia. We undertook this open pilot study in order to asses whether a low subcutaneous (s.c.) dose of Epoetin alfa would prove as effective and well tolerated as the higher i.v. dose. Such a move would also decrease costs. Materials and methods: A total Epoetin alfa s.c. dose of 800 IU/kg was compared with a total i.v. dose of 1,800 IU/kg. Twenty-two rheumatoid arthritis patients, unable to donate because of hemoglobin (Hb) <11 g/dl, received 300 IU/kg of IV Epoetin alfa twice weekly for 3 weeks (11 patients), or 100 IU/kg of s.c. Epoetin alfa twice weekly for 3 weeks plus an i.v. bolus of 200 IU/kg of Epoetin alfa at the first visit (11 patients). At each visit, all patients received 100 mg of i.v. iron saccharate and when the hematocrit (hct) 34%, 350 ml of autologous blood (AB) were collected. Results: No significant differences were observed between the 2 groups of treated patients in terms of units of AB collected (2.6±0.6 vs. 2.5±0.5 units for i.v. and s.c. groups, respectively), ml of RBC produced during the study period (291±99 vs. 337±65 ml for the i.v. and s.c. groups, respectively), or in the degree of reduced exposure to allogeneic blood in comparison with the control group. Conclusions: Lower dose of Epoetin alfa (reduced by 56%), supplemented by i.v. iron, is as effective and well tolerated as higher doses administered i.v., supplemented by i.v. iron.     

Risk of development of clinical and pathogenetic features of anemia on the background of basic therapy of inflammatory bowel disease

Anemia in IBD is the result of a combination of iron deficiency and anemia of chronic disease. Therapy of IBD is relief of inflammation, but the drugs usage may cause the development hemolytic anemia and myelodysplastic syndrome. We studied the effect of basic therapy on the incidence of anemia and assess the impact of modern biological therapies on the main markers of AHZ. A total of 153 patients with ulcerative colitis (UC) and 53 patients with Crohn's disease (CD), which at the time of the study received basic anti-inflammatory therapy for at least 1 year. All patients underwent blood tests, iron metabolism parameters were determined by the level of erythropoietin and G-gepsidina C reactive protein. Modern biological therapy increases the effectiveness of the treatment of anemia in patients with IBD. The use of Remicade gives a quick positive response, which is due to the decrease of gepsidin negative influence on iron metabolism and unlocking the synthesis of erythropoietin. The use of MSCs does not inhibit the synthesis of erythropoietin, and is likely to stimulate erythropoiesis at the erythroblast precursors.