Erythropoietin and

Rubella Vaccine, Live Mumps Vaccine, rDNA Hepatitis B Vaccine, Oral Poliovirus Vaccine, Erythropoietin, and Factor IX etcetera. 

Less blood loss and iron deficiency, resulting in easier management of anemia or reduced requirements for erythropoietin and parenteral iron. 

The kidneys are located on the posterior part of the abdomen on either side of the spine, below the diaphragm, and behind the liver and stomach. They are bean-shaped and weigh approximately 150 grams (0.33 lb) each. The primary function of the kidneys is excretion. They work to excrete waste products through a series of steps involving glomerular filtration, secretion, and reabsorption. The kidneys also have several endocrine (e.g., production of erythropoietin and renin) and metabolic (e.g., vitamin D activation and drug metabolism) functions. 

Assess appropriate selection of these medications for pharmacokinetic and pharmacodynamic DDIs (Table 52-6), need (e.g., do renal transplant recipients need to continue to take erythropoietin ), and efficacy. 

Studies have shown that in patients with chemotherapy-related anemia, therapy with erythropoietin products (epoetin-alfa and darbepoetin) can increase hemoglobin, decrease transfusion requirements, and improve quality of life.12 Epoetin is recombinant human erythropoietin, and darbepoetin is structurally similar to endogenous erythropoietin. Both bind to the same receptor to stimulate red blood cell production. Darbepoetin differs from epoetin in that it is a glycosylated form and exhibits a longer half-life in the body. The half-lives of a single subcutaneous injection of epoetin or darbepoetin in patients are roughly 27 and 43 hours, respectively. 

Although EPO deficiency is the primary cause of CKD anemia, iron deficiency is often present, and it is essential to assess and monitor the CKD patient s iron status (NKF-K/DOQI guidelines). Iron stores in patients with CKD should be maintained so that transferrin saturation (TSAT) is greater than 20% and serum ferritin is greater than 100 ng/mL (100 mcg/L or 225 pmol/L). If iron stores are not maintained appropriately, epoetin or darbepoetin will not be effective, and most CKD patients will require iron supplementation. Oral iron therapy can be used, but it is often ineffective, particularly in CKD patients on dialysis. Therefore, intravenous iron therapy is used extensively in these patients. Details of the pharmacology, pharmacokinetics, adverse effects, interactions, dose, and administration of erythropoietin and iron products have been discussed previously. 

Hoke, A. (ed.). 2006. Erythropoietin and the Nervous System. Springer Verlag. 

Bottomley, A., Thomas, R., van Steen, K., Flechtner, H., Djulbegovic, B. 2002. Human recombinant erythropoietin and quality of life a wonder drug or something to wonder about Lancet Oncology 3(3), 145-153. 

Figure 4.8 Erythropoietin. Source Cheetham JC, Smith DM, Aoki KH, et al. NMR structure of human erythropoietin and a comparison with its receptor bound conformation, Nature Structural Biology 5 861-866 (1998).)...

Erythropoietin and Neural stem cell Stem Cell Phase II... 

H. Wu, U. Klingmuller, P. Besmer, and H. F. Lodish, Interaction of the erythropoietin and stem-cell-factor receptors, Nature Ml, 242-246 (1995). 

In addition to their involvement in excretion and metabolism, the kidneys also have endocrine functions. They produce the hormones erythropoietin and calcitriol and play a decisive part in producing the hormone angiotensin II by releasing the enzyme renin. Renal prostaglandins (see p. 390) have a local effect on Na resorption. 

Pure red cell aplasia (PRCA) PRCA has been reported in a limited number of patients exposed to epoetin alfa. This has been reported predominantly in patients with CRF. Evaluate any patient with loss of response to epoetin alfa for the etiology of loss of effect. Discontinue epoetin alfa in any patient with evidence of PRCA and evaluate the patient for the presence of binding and neutralizing antibodies to epoetin alfa, native erythropoietin, and any other recombinant erythropoietin administered to the patient. In patients with PRCA secondary to neutralizing antibodies to erythropoietin, do not administer epoetin alfa, and do not switch such patients to another product as anti-erythropoietin antibodies cross-react with other erythropoietins. 

Silverberg DS, Wexler D, Blum M, et al. The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol. Jun 2000 35(7) 1737-1744. 

Spivak, J. (1994). Recombinant human erythropoietin and the anaemia of cancer. Blood 84(4), 997-1004. 

Bianco et al. [34] CNT-r proteins (fibrinogen, protein A, erythropoietin, and apolipoprotein) CNT-TEG-short protein complex quickly entered fibroblasts and other cells, sometimes migrated to their nuclei. Proteins executed their normal biological functions... 

Twenty years passed before researchers purified small amounts of erythropoietin and elucidated the primary amino-acid structure. Erythropoietin has 166 amino-acid residues and a molecular weight of 18.4kDa. The overall molecular weight is... 

Caution Several cases of hepatocellular carcinoma have been reported in patients with aplastic anemia treated with androgen anabolic therapy. Erythropoietin and colony-stimulating factors (see Chapter 33) should be used instead. 

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