Erythropoietin

What is erythropoietin?

Red blood cells are produced in the bone marrow (the spongy tissue inside the bone). In order to make red blood cells, the body maintains an adequate supply of erythropoietin (EPO), a hormone that is produced by the kidney.

EPO helps make red blood cells. Having more red blood cells raises your hemoglobin levels. Hemoglobin is the protein in red blood cells that helps blood carry oxygen throughout the body.

Anemia is a disorder that occurs when there is not enough hemoglobin in a person's blood. There are several different causes of anemia. It can be related to blood loss, vitamin and mineral deficiency, renal disease, medication, etc. In many cases if we treat the underlying cause the anemia will resolve. In certain situations erythropoietin is administered to avoid transfusion of if the anemia will not respond to other therapy.

What is recombinant erythropoietin?

Recombinant erythropoietin is a man-made version of natural erythropoietin. It is produced by cloning the gene for erythropoietin. It does not contain any human plasma or blood products.

These drugs are given either intravenously or subcutaneously (under the skin) and work by stimulating the bone marrow to produce more red blood cells. These cells are then released from the bone marrow into the bloodstream.

There are two EPO products on the U.S. market: epoetin alfa (Procrit ® Epogen®).

Who receives EPO?

EPO is usually given to patients who have a low hemoglobin related to chronic (long-lasting) kidney disease, cancer or to patients who have anemia that is not responding to other therapy.

EPO is also used in patients are going to have a surgery in which significant blood loss is expected. By administering EPO in the month before the surgery the patient often has a 1-2 gram rise in hemoglobin and this decreases the chance that a blood transfusion will be needed during the surgery.

What are the side effects of EPO?

Generally EPO is very well tolerated without major side effects. If side effects occur they may include:

• High blood pressure
• Swelling
• Fever
• Dizziness
• Nausea
• Pain at the site of the injection.
• Excess hemoglobin production and/or blood clots. Very unlikely with short term EPO.

Who should not receive EPO?

Patients with:

• Heart disease
• High blood pressure
• Porphyria (a group of diseases that are caused by enzyme deficiencies)
• Seizures
• An allergy to epoetin alfa or any other part of this medicine
• Uncontrolled high blood pressure

Other issues to consider:

• When using EPO before surgery it is often administered once weekly for 3-5 doses.
• The first dose should always be given in a clinic setting. Subsequent doses can be given at home or in a clinic.
• With this short term EPO, a hemoglobin is usually checked every other week. This can be performed by finger poke.
• Iron supplements are often needed for patients who are on EPO.
• Check blood pressure and heart rate as recommended by your health care provider.
• Remain informed about the results from any blood work that is done.
• If you have any questions or problems, please contact your hematologist.

Reviewed 6/2017

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