What is the role of erythropoietin (EPO) in the treatment of hemolytic anemia?

Updated: May 27, 2021
  • Author: Srikanth Nagalla, MD, MS, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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Erythropoietin (EPO) has been used to try to reduce transfusion requirements, with variable outcomes. Settings in which EPO therapy has reduced transfusion requirements include the following:

  • Children with chronic renal failure [49]

  • Autoimmune hemolytic anemia associated with reticulocytopenia [50]

  • A patient with sickle cell disease undergoing hemodialysis for renal failure [51]

  • Jehovah’s Witnesses [52]

  • Infants with hereditary spherocytosis [53, 54]

However, the ability of EPO to reduce transfusion requirement has been questioned in newborns with hereditary spherocytosis [55] and in post-diarrheal hemolytic uremic syndrome. [56]

There is a general impression that additional studies should be carried out to establish the role and indications for EPO in hemolytic disorders. EPO therapy costs more than transfusions. The potential for EPO-induced cardiovascular complications needs to be considered. EPO has pleiotropic effects and might inhibit macrophages in Salmonella infections. [57] EPO was reported to be helpful in treating cerebral malaria due to itspleiotropic effect and not its hematopoietic action. [58] Hence, EPO should be used judiciously.

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