What is erythropoietin and when is it used as an alternative to transfusion?

Updated: Apr 16, 2019
  • Author: Linda L Maerz, MD, FACS, FCCM; Chief Editor: Emmanuel C Besa, MD  more...
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The use of erythropoiesis-stimulating proteins for the treatment of chemotherapy-induced anemia is well established. [68] Anemia is also exceedingly common in critically ill patients and in those with multiple injuries.

Anemia is a result of the cumulative effects of blood loss (ie, splenic autodestruction from red cell senescence, blood drawing for laboratory sampling, operative losses) and decreased RBC production. Decreased RBC production results from abnormal iron metabolism, inappropriately low erythropoietin production, diminished response to erythropoietin, and direct suppression of RBC production.

Recombinant human erythropoietin (rHuEPO) increases hemoglobin and hematocrit values and decreases the number of RBC transfusions in ICU patients, but further studies are needed to determine whether this therapy has a positive impact on outcome and whether the benefits justify the cost of therapy. Intuitively, erythropoietin should be cost effective by reducing the risks of allogeneic transfusion even if the erythropoietin cost was equivalent to the cost of the units of red cells saved. However, potential future cost avoidance is not always accepted as justification for expensive therapy.

Patients with suboptimal initial hemoglobin levels undergoing elective surgery can also be treated with rHuEPO, either preoperatively or postoperatively, with great efficacy. [69, 70] Correction of nutritional deficiency may also enhance RBC production; adequate amounts of protein intake, iron, folate, vitamin B12, and vitamin C are all important in this regard. [71]

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