Effect of blood transfusion versus erythropoietin injection on peripheral erythropoietin response in burnt patients

Twenty-seven adult burned patients [burn size 20-40% of total body surface area] were included in this study. The studied patients were blindly and randomly assigned into two groups: Group A [15 patients] received blood transfusion according to their need, while group B [12 patients] received 4000 units of r-HuEPO twice weekly for one month. Blood transfusion was given to both groups when haemoglobin level decreased to less than 8 g/dl. The effect of administered blood transfusion or r-HuEPO was evaluated through clinical response, blood count, reticulocytic count, serum iron and transferrin and erythropoietin level. The mean values of hemoglobin, packed red cell volume and RBCs count of both groups were progressively decreased, especially in the 3rd post burn day. Despite the progressive decrease of all the previous hematological values in both groups, they had elevated serum erythropoietin level allover the post burn period, which was significantly higher in group B. Moreover, significant reticulocytosis was observed, especially in group B. Before the administration of either blood transfusion or r-HuEPO, iron levels were within the normal range, then rapidly reached extremely low levels and remained low throughout the study periods in group B. On the contrary, in group A, serum iron levels were rapidly increased and reached high levels and remained high throughout the study periods. Moreover, serum ferritin levels were rapidly reaching supernormal values and remained higher allover the study, but the level of transferrin was low in the follow up period compared with that of the first days. The study concluded that recombinant human erythropoietin [r-HuEPO] is capable of enhancing erythropoiesis and has lower risk of iron overload than frequent blood transfusions in burned patients