Erythropoietin: sites of synthesis and regulation of secretion.
Erythropoietin (Epo) is a glycoprotein that promotes the proliferation and differentiation of erythrocyte precursors.
The major site of Epo production is the kidney, while the liver is the main extrarenal site of Epo production.
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1. Anemia caused by renal insufficiency, including dialysis and non-dialysis patients.
2. Surgical perioperative red blood cell mobilization.
1. Renal anemia:
This product should be used under the guidance of a doctor. It can be administered subcutaneously or intravenously, 2 to 3 times a week.
The dose to be administered is adjusted according to the patient’s degree of anemia, age and other relevant factors.
Treatment period: 100 to 150 IU/kg per week for recommended hemodialysis patients and 75 to 100 IU/kg for non-dialysis patients.
If the hematocrit increases by less than 0.5 vol% per week, the dose may be increased by 15 to 30 IU/kg after 4 weeks, but the maximum dose may not exceed 30 IU/kg/week.
Hematocrit should be increased to 30 to 33 vol%, but should not exceed 36 vol% (34 vol%).
If the hematocrit reaches 30 to 33 vol% or / and hemoglobin reaches 100 to 110 g / liter, it enters the maintenance treatment phase.
It is recommended to adjust the dose to 2/3 of the therapeutic dose and then check the hematocrit every 2 to 4 weeks to adjust the dose to avoid erythropoiesis, maintain hematocrit and hemoglobin at appropriate levels.
2. Surgical perioperative red blood cell mobilization:
- Applicable to elective surgical patients with preoperative hemoglobin at 100-130 g/l (except for cardiac vascular surgery),
- The dosage is 150 IU/kg, 3 times a week.
- Subcutaneous injection, applied from 10 days before surgery to 4 days after surgery,
- Can reduce intraoperative and postoperative anemia,
- Reduce the need for allogeneic blood transfusions,
- Accelerate the recovery of postoperative anemia.
In order to prevent iron deficiency, the iron can be supplemented at the same time.
1. General reaction:
A small number of patients may have headaches, low fever, fatigue, etc. at the beginning of the medication. Individual patients may have myalgia and joint pain.
Most of the adverse reactions can be improved after symptomatic treatment, and will not affect the continued use of the drug. In some cases, the above symptoms persist and should be considered for withdrawal.
2. Allergic reactions:
Very few patients may develop allergic reactions such as rash or urticaria after medication, including anaphylactic shock.
Therefore, when using this product for the first time or when using this product again,
It is recommended to use a small amount first, and then confirm that there is no abnormal reaction, and then inject the whole amount.
If abnormalities are found, stop the drug immediately and dispose of it properly.
3. Cardiovascular system:
High blood pressure,
The original hypertension is worsening and there are headaches, disturbances of consciousness, and spasms due to hypertensive encephalopathy.
It can even cause cerebral hemorrhage.
Therefore, attention should be paid to the changes in blood pressure during the treatment of erythropoietin injection.
If necessary, reduce or discontinue the drug and adjust the dose of antihypertensive drugs.
4. Blood system:
As the hematocrit increases, the blood viscosity can be significantly increased.
Therefore, care should be taken to prevent thrombosis.
5. Liver: Occasionally, GOT and GPT rise.
6. Gastrointestinal: Sometimes nausea, vomiting, loss of appetite, diarrhea, etc. occur.
1. Uncontrolled patients with severe hypertension.
2. Those who are allergic to this product and other mammalian cell derivatives, allergic to human serum albumin.
3. Infected patients, should control the infection and then use this product.
1. During the administration of this product, the hematocrit should be checked regularly (once every week, once every two weeks), to avoid excessive erythropoiesis (confirmation of hematocrit below 36 vol%), if excessive Red blood cell growth should be treated appropriately with a pause in medication.
2. The application of this product may cause mild elevation of serum potassium. The diet should be adjusted appropriately. If the blood potassium level rises, the dosage should be adjusted according to the doctor’s advice.
3. For patients with myocardial infarction, pulmonary infarction, cerebral infarction, patients with a history of drug allergy and patients with allergic tendency should be carefully administered.
4. The demand for iron increased due to effective hematopoiesis during treatment.
A drop in serum iron concentration usually occurs. If the patient’s serum ferritin is below 100 ng/ml, or if the transferrin saturation is less than 20%, iron should be replenished daily.
5. Folic acid or vitamin B12 deficiency will reduce the efficacy of this product. Excessive aluminum can also affect the efficacy.
Erythropoietin (EPO) definition and facts
Erythropoietin (EPO) is a hormone produced by the kidney.
Erythropoietin promotes the formation of red blood cells by the bone marrow.
The erythropoietin hormone level can be detected and measured in the blood (the EPO test).
Measurement of the blood erythropoietin level can be used to detect certain medical conditions.
Erythropoietin can be synthesized and used as a treatment of some forms of anemia.
Erythropoietin has been misused as a performance-enhancing drug by some athletes.