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In Reply: We disagree with Drs Bagshaw and Ghali that our study contradicts the results of Hebert et al,¹ who reported worse clinical outcomes associated with a "liberal" transfusion strategy. Our study was not designed to address that question. While the transfusion practice in our study was consistent with standard practice, it differed from both the liberal and the restrictive transfusion group in the study of Hebert et al.

We agree that cost is an important issue. As both we and Dr Carson² pointed out, determination of the ultimate cost-effectiveness of rHuEPO therapy involves consideration of numerous factors beyond merely the dollar costs of blood vs those of erythropoietin. Further study is still needed to explore potential clinical outcome benefits associated with erythropoietin therapy in this setting.

We did not observe any patients with red-cell aplasia in our study, which had a follow-up of 28 days. To date this uncommon . . . [Full Text of this Article]

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