To the Editor. —
The recent study of the human erythropoietin response to autologous donation1 concluded that the current guidelines for autologous blood banking (hematocrit >0.34) do not allow a significant degree of anemia to develop in patients. Increased levels of erythropoietin and erythropoiesis were not observed, implying that preoperative autologous storage may not increase the total red blood cell mass at the time of surgery.These findings may be methodological artifacts typical of suboptimal clinical predonation programs. Most patients deposited 3 U or less at three-day intervals over a short period (nine to 12 days). The spontaneous erythropoietic response to sustained phlebotomy-induced anemia requires seven to nine days to initiate and becomes maximal at three weeks, with adequate iron stores.2 Phlebotomy is best begun four to five weeks from the date of planned surgery. This maximizes the preoperative period of increased erythropoiesis, within the limits of liquid
Kempen PM. Repeated Blood Donations and Erythropoietin Levels. JAMA. 1989;261(10):1443. doi:10.1001/jama.1989.03420100077019
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