Erythropoietin therapy

AL. Erythropoietin therapy for acute stroke is both safe and beneficial. Mol Med... 

Erythropoietin level 2-25 mlU/mL (2-25 IU/L) Palicnls may benefit from erythropoietin therapy if they are anemic and erythropoietin levels are normal or mildly elevated. 

Besides anemia associated with cancer and CKD, anemia of chronic disease can result from inflammatory processes and occurs commonly in autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. In treating these types of anemia of chronic disease, the most important principle is treating the underlying disease. These patients also may have iron deficiency and should be treated in the manner already discussed. Erythropoietin therapy such as epoetin-alfa therapy at a dose of 150 units/kg three times a week also may be used in these patients. 

Corwin, H. 2006. The role of erythropoietin therapy in the critically ill. Transfusion Medicine Reviews 20(1), 27-33. 

Goodnough LT, Monk TG, Andriole GL. Current concepts erythropoietin therapy. N Engl J Med 1997 336 933-8. 

Iron deficiency anemia For the treatment of iron deficiency anemia in patients undergoing chronic hemodialysis who are receiving supplemental erythropoietin therapy. 

L.B. Sheiner. 1992. A pharmacodynamic model of erythropoietin therapy for uremic anemia. Clin. Pharmacol. Ther. 51 76-89. 

Ehrenreich H, Hasselblatt M, Dembowski C, Depek L, Lewczuk P, Stiefel M, RustenbeckH- H, BreiterN, Jacob S, Knerlich F, Bohn M, Poser W, Rither E, Kochen M, Gefeller O, Gleiter C, Wessel TC, De Ryck M, Itri L, Prange H, Cerami A, Brines M, Siren A-L (2002) Erythropoietin therapy for acute stroke is both safe and beneficial. Molecular Medicine 8 495-505. 

Mingoli A, Sapienza P, Puggioni A, Modini C, Cavallaro A. A possible side-effect of human erythropoietin therapy thrombosis of peripheral arterial reconstruction. Eur J Vase Endovasc Surg 1999 18(3) 273. ... 

Morris AT, Ronco C. Erythropoietin therapy in peritoneal dialysis patients. Perit Dial Int 2000 20(Suppl 2) S178-82. 

Makis AC, Chaliasos N, Hatzimichael EC, Bourantas KL. Recombinant human erythropoietin therapy in a transfusion-dependent beta-thalassemia major patient. Aim Hematol 2001 80(8) 492-5. 

Levin N. Management of blood pressme changes during recombinant human erythropoietin therapy. Semin Nephrol 1989 9(1 Suppl 2) 16-20. 

Swaminathan S, Ahmed I, McCarthy JT, Albright RC, Pittelkow MR, Caplice NM, Griffin MD, Leung N Nephrogenic fibrosing dermopathy and high-dose erythropoietin therapy. Ann Intern Med 145 234-235, 2006. 

Hayashi T, Suzuki A, Shoji T, Togawa M, Okada N, Tsubakfiiara Y, et al. Cardiovascular effect of normalizing the hematocrit level during erythropoietin therapy in predialysis patients with chronic renal failure. Am J Kidney Dis 2000 35 250-6. 

Revicki DA, Brown RE, Feeny DH, Henry D, Teehan BP, Rudnick MR, et al. Health-related quality of life associated with recombinant human erythropoietin therapy for predialysis chronic renal disease patients. Am J Kidney Dis 1995 25 548-54. 

Becker BN, Becker YT, Leverson GE, Heisey DM. Erythropoietin therapy may retard progression in chronic renal transplant dysfunction. Nephrol Dial Transplant 2002 17 1667-1673. 

Indication Treatment of iron deficiency anemia in patients undergoing chronic hemodialysis who are receiving supplemental erythropoietin therapy Treatment of patients with documented iron deficiency in whom oral therapy is unsatisfactory or impossible Treatment of iron deficiency anemia in patients undergoing chronic hemodialysis who are receiving supplemental epoetin alfa therapy... 

Erythropoietin therapy has been used in only a limited nnmber of patients with SCD and the clinical results have been inconsistent therefore its rontine use in these patients cannot be recommended. When used in combination with hydroxyurea, erythropoietin increases HbF levels to a greater extent than hydroxyurea alone. This suggests that there may be a role for addition of erythropoietin therapy in patients who do not respond to hydroxyurea alone, although more studies are needed. Other proposed combinations are hydroxyurea combined with either penylbutyrate or clotrimazole, based on their different mechanisms of action. ... 

Recombinant erythropoietin therapy, in conjunction with adequate iron intake, can be highly effective in a number of anemias, especially those associated with a poor erythropoietic response. There is a clear dose-response relationship between the epoetin alfa dose and the rise in hematocrit in anephric patients, with eradication of their anemia at higher doses. Epoetin alfa is also effective in the treatment of anemias associated with surgery, acquired immunodeficiency syndrome (AIDS), cancer chemotherapy,... 

During erythropoietin therapy, absolute or functional iron deficiency may develop. Functional iron deficiency (i.e., normal ferritin levels but low transferrin saturation) presumably results from the inability to mobilize iron stores rapidly enough to support the increased erythropoiesis. Virtually all patients eventually will require supplemental iron to increase or maintain transferrin saturation to levels that will adequately support stimulated erythropoiesis. Supplemental iron therapy is recommended for all patients whose serum ferritin is below 100 pg/L or whose serum transferrin saturation is less than 20%. 

More recently, novel erythropoiesis-stimulating protein (NESP) or darbapoetin alfa (Aranesp) has been approved for clinical use in patients with indications similar to those for epoetin alfa. It is a genetically modified form of erythropoietin in which four amino acids have been mutated such that additional carbohydrate side chains are added during its synthesis, prolonging the circulatory survival of the dmg to 24 to 26 hours. Recombinant erythropoietin therapy, in conjunction with adequate iron intake, can be highly effective... 

Iron-deficiency anemia results from dietary intake of iron that is inadequate to meet normal requirements (nutritional iron deficiency), blood loss, or interference with iron absorption. Most nutritional iron deficiency in the U.S. is mild. More severe iron deficiency is usually the result of blood loss, either from the GI tract, or in women, from the uterus. Impaired absorption of iron from food results most often from partial gastrectomy or malabsorption in the small intestine. Finally, erythropoietin therapy can result in a functional iron deficiency. 

Bommer J, Alexiou U, Muller-Buhl E, et al. (1987). Recombinant human erythropoietin therapy in haemodialysis patients-dose determination and clinical experience. Nephrol. Dial. Transpl. 2 238-242. 

Huang T P, Lin C Y (1995). Intraperitoneal recombinant human erythropoietin therapy Influence of the duration of continuous ambulatory peritoneal dialysis treatment and peritonitis. Am. J. Nephrol. 15 312-317. 

Kato A, TakitaT, Furuhashil Takahashi T, Maruyama Y, HishidaA. No effect of losartan on response to erythropoietin therapy in patients undergoing hemodialysis. Nephron (2000) 86, 538-9. 

Other hemoglobinopathies including the rare unstable haemoglobin Hb Olmsted, thrombophilia, leukemias and myeloma and erythropoietin therapy have also been associated with priapism (Quigley and Fawcett 1999). 

Myelosuppression is dose dependent monitoring white blood counts is usually sufficient for detecting bone marrow suppression. The nadir white blood cell count is usually encountered 9 days after an IV dose, but the range can be 6 to 21 days (215). Monocytosis is an early indicator of bone marrow recovery from chemotherapy, while low monocyte counts portend prolonged leukopenia (216). Anemia is a consequence of chronic CP use. Patients with hemoglobin levels of less than 11 gm% should be considered for erythropoietin therapy (217). 

Raine AEG (1988). Hypertension, blood viscosity, and cardiovascular morbidity in renal failure implications of erythropoietin therapy. Lancet, 1(8557) 97-100. 

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