home Audience 12 Highly active glycoprotein hormone erythropoietin: what it is, the norm of the regulator of erythropoiesis, causes and symptoms of deviations. The importance of erythropoietin in the body and ways to regulate its level

Highly active glycoprotein hormone erythropoietin: what it is, the norm of the regulator of erythropoiesis, causes and symptoms of deviations. The importance of erythropoietin in the body and ways to regulate its level

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The basis for the treatment of hemodialysis anemia is strict adherence to the principles of hemodialysis technology, the effectiveness of the hemodialysis dose, cleanliness, treatment of intercurrent diseases, elimination of factors of meaningless anemia and correction of iron deficiency. The hemoglobin level in a dialysis patient is one of the integral indicators of all our work in absolutely every respect. So let's ask ourselves a number of questions.

· Is there any confidence that the reverse osmosis system works flawlessly and that the water for hemodialysis does not exceed the maximum permissible values for chemical and bacterial contamination?

· What is the concentrate? Do all salts comply with pharmacopoeial qualifications?

· Is the dialysate composition correct?

· What is the dose of hemodialysis? What is Kt/V? If we count on something, then Kt/V >1.2 is required. Not everything is simple here. It is necessary to evaluate both the efficiency of the dialyzer and whether the vascular access allows for a blood perfusion rate of 300 ml/min or more.

· Is hemodialysis time enough?

· Is the dialyzer washed with the required amount of saline before connecting?

· Is the patient's nutrition adequate in terms of caloric content?

· It wouldn't be a bad idea to take a look at the hemodialyzer after it's turned off. Is the residual blood loss excessive? Maybe you need to increase the dose of heparin?

· After hemodialysis, do fistula puncture sites bleed for too long? Maybe you need to reduce the dose of heparin?

· Are you anemicizing the patient by excessive sampling (taking blood for testing)?

· Does blood trauma occur during extracorporeal circulation?

· Do the staff treat every drop of the patient’s blood with care when connecting/disconnecting?

· Does the patient have any intercurrent diseases? Maybe we need to do a gastroscopy? A chronic infection? Heavy menstrual bleeding can be a very serious factor in anemia.

· Are you sick enough to be out in the fresh air?

· Isn't drug abuse the cause of anemia due to their accumulation?

So, the treatment of anemia begins with eliminating the factors of anemia: technological, residual blood loss, excessive sampling, ensuring a sufficient hemodialysis dose, etc.Professor G.D. Shostka rightly believes that in this way it is possible to ensure a hemoglobin level of 80-100 g/l or a hematocrit of 25-30% in most patients without any erythropoietin. And it is true: according to Ifudu (1997), there is a moderate correlation between the level of hematocrit and the degree of reduction in urea levels during hemodialysis.In fact, hemodialysis anemia is not at all caused by erythropoietin deficiency alone. This is confirmed by the study of Schmiedler et al. (1997), which showed that the level of hematocrit in dialysis patients correlates very weakly with the level of endogenous erythropoietin.Until recently, the optimal hematocrit level was considered to be 30-36%. When the hematocrit is below 30%, the risk for the patient begins to increase significantly. There is not yet enough information regarding the normal hematocrit and its usefulness for hemodialysis patients.The most latest research showed that even a hematocrit of 30% is not optimal for the patient. According to Prof. A. Collins (1997), the risk for a hemodialysis patient is minimal at a hematocrit of 35%.
World experience shows that even with a sufficient dialysis dose and a good level of nutrition, 25% of patients cannot achieve an acceptable hematocrit level without erythropoietin. Therefore, erythropoietin is one of the main factors of long-term survival in a significant proportion of patients.

What is erythropoietin?

Erythropoietin (EPO) is a hormone produced by the kidneys that promotes the formation of red blood cells in the bone marrow.

The cells in the kidneys that are specialized are erythropoietin in that they are sensitive to low levels of oxygen in the blood that passes through the kidneys. These cells make and release erythropoietin when oxygen levels are too low. Low oxygen levels may indicate anemia, a decrease in the number of red blood cells, or hemoglobin molecules that carry oxygen throughout the body.

Chemically, what is erythropoietin (EPO)?

Erythropoietin is a protein with an attached sugar (a glycoprotein). It is one of a number of similar glycoproteins that act as growth promoters in specific types of blood cells in the bone marrow.

What exactly does erythropoietin (EPO) do?

Erythropoietin stimulates the bone marrow to produce more red blood cells. As a result of this growth in red cells the oxygen carrying capacity of the blood increases.

As stated by the Prime Regulator of Red Cell Production, erythropoietin's main functions are:

Stimulating the development of red blood cells.

Initiate the synthesis of hemoglobin, a molecule in red blood cells that carries oxygen.

Is the kidney the only source of erythropoietin?

Erythropoietin is produced to a lesser extent by the liver. Only about 10% of erythropoietin is made in the liver. The erythropoietin gene has been found on human chromosome 7 (at 7q21). Different DNA wing sequences in the Erythropoietin gene act to control liver, kidney, and erythropoietin production.

Why is it important to know the level of erythropoietin in the blood?

The hormone erythropoietin can be detected and measured in the blood. The level of erythropoietin in the blood may indicate bone marrow disorders (such as polycythemia, or increased red blood cell production), kidney disease, or erythropoietin abuse. Testing blood erythropoietin levels is therefore of no cost if:

Too little erythropoietin may be responsible for too few red blood cells (for example, when evaluating anemia, especially anemia associated with kidney disease).

Too much erythropoietin may cause too many red blood cells

Too much erythropoietin may be evidence for

Too much in Erythropoietin an athlete can suggest Erythropoietin abuse.

How is erythropoietin analyzed?

The patient is usually asked to fast for 8-10 hours (at night), and sometimes lie still and rest for 20 or 30 minutes before the test begins. The test requires a routine blood sample, which is sent to a laboratory for analysis.

What are normal erythropoietin levels?

Normal erythropoietin levels range from 4 to 24 mu/ml (milliunits per milliliter).

What is abnormal erythropoietin level to report?

Smaller compared to normal values erythropoietin is considered, for example, for anemia due to chronic (long-term) renal failure.

Elevated levels of erythropoietin can be seen, for example, in polycythemia rubra Vera, a disorder characterized by an excess of red blood cells.

The correct interpretation of abnormal erythropoietin levels depends on the specific clinical situation.

Can a person without medical illness or states have high level erythropoietin?

Yes. For example, erythropoietin has been used as an indicator of drug-enhancing drugs in athletes such as cyclists (in the Tour de France), long-distance runners, speed roller skaters, and Nordic (cross-country) skiers. If misused in such situations, erythropoietin is considered particularly dangerous (perhaps because due to dehydration, vigorous exercise can further increase the thickness (viscosity) of the blood, which increases the risk of heart attacks and strokes. Erythropoietin has been banned from the Tour de France, the Olympics and other sports organizations.

Is erythropoietin available as a prescribed medication?

Yes. Using recombinant DNA technology, erythropoietin has been synthetically produced for use as a treatment for individuals having certain types of anemia. Erythropoietin can be used to reverse anemia by stimulating red blood cell production in the bone marrow under these conditions. The drug is called epoetin Alfa (Epogen, Procrit). It can be given as a single injection intravenously (into a vein) or subcutaneously (under the skin).

What are the clinical uses of erythropoietin?

Erythropoietin is used in many medical institutions. The most common use is in people with anemia ( low blood) associated with kidney dysfunction. When the kidneys do not function properly, they produce less than normal amounts of erythropoietin, which can lead to low red blood cell production, or anemia. Therefore, by replacing erythropoietin with synthetic erythropoietin injection, anemia associated with kidney disease can be treated. Currently, Epogen or Procrit is a standard part of therapy in patients with kidney disease who require dialysis to both treat and prevent anemia.

Other uses of erythropoietin may include treating anemia associated with the drug AZT (used to treat AIDS) and anemia associated with cancer.

Erythropoietin Brief Overview

Erythropoietin (EPO) is a hormone produced by the kidneys.

Erythropoietin promotes the formation of red blood cells in the bone marrow.

Erythropoietin hormone levels can be detected and measured in the blood (EPO test).

Measuring blood erythropoietin levels can be used to identify certain conditions.

Erythropoietin can be generalized and used as a treatment for some forms of anemia.

Erythropoietin has been used as an indicator of drug enhancement by some athletes.

Treatment with iron supplements

Now let's discuss the problems of anemia directly. To do this, it is necessary to examine iron reserves in the body (Table 14-1).
Table 14-1. Iron reserves in the body

Metabolite
Hemoglobin
Ferritin
Other

So, everything is very simple! In the body, iron is found almost exclusively in hemoglobin and ferritin. The iron content in myoglobin and some enzymes is insignificant and amounts to only 5%. Obviously, to assess iron reserves, it is quite sufficient to determine the level of hemoglobin and ferritin. All other sophisticated indicators of iron metabolism can be neglected in practical work.
A slight iron deficiency is not dangerous, but its excess (surplus) leads to hypersideremia and hemosiderosis, which has a negative effect on the heart and liver and makes the patient susceptible to infection. If there is an excess of iron, the first step is to discontinue iron supplements, especially their parenteral administration.
Desferal is currently used to treat hemosiderosis. Therapy with this drug requires special consideration. Very effective way The treatment for hypersideremia is Eprex. In case of anemia and hypersideremia, Eprex quickly reduces iron overload due to its utilization for hemoglobin synthesis.When prescribing Eprex to a patient, we must ensure, in addition to the dialysis dose and nutrition, adequate iron intake. Many people mistakenly believe that dietary compensation for iron deficiency is possible. No foods, even those with the highest iron content, can compensate for its deficiency. Indeed: half of the iron received from food is in an insoluble state and does not affect its balance at all; about half of the dissolved iron is retained by the intestinal mucosa and barely 10% of dietary iron is absorbed.So, replacing iron deficiency orally is relatively safe for the patient, since the mucosal barrier prevents the development of hypersideremia and hemosiderosis. Please note: the administration of oral iron supplements to patients who have excess iron practically does not lead to an increase in its concentration in the blood.
But, on the other hand, oral iron replacement is practically unpredictable. Iron contained in meat and liver is best absorbed.
Among enteral iron preparations, the most effective are Ferro-Gradumet, which is absorbed only in the intestines and does not irritate the gastric mucosa, as well as Ferroplex.
Parenteral administration of iron preparations (for example, Ferrum-Lek) requires very careful monitoring. Without qualified monitoring, parenteral administration of iron can quickly lead to hypersideremia and hemosiderosis.
Along with iron supplements, it is recommended to prescribe B vitamins and folic acid. The benefits of prescribing large doses of vitamin C have not yet been proven.
Table 14-2. Oral vitamin supplement in the treatment of anemia

Vitamin	Daily supplement
Thiamine (B 1)	3 mg
Folic acid	3 mg
Riboflavin (B 2 )	3 mg
Pyridoxine (B 6 )	10 mg
Cyanocobalamin (B 12)	3 mcg
Ascorbic acid (C)	100 mg

By the way, if a patient has threatening anemia, it is not a sin to inject him with erythromass. After all, measures to correct anemia do not produce an effect immediately, but gradually.

Principles of oral iron therapy(reported by Fishbane S. Maesaka J.K. // Am. J. Kidney Dis. - 1997. - Vol. 29. - P. 319-333):

· take the pill at empty stomach or at least not earlier than 2 hours after the last meal;

· if drugs are used to reduce gastric secretion, oral administration of iron is useless; the only exception is small dose histamine blockers before bedtime;

· the dose of vitamin C as an iron supplement should not exceed 100 mg/day;

· Enteric-coated iron preparations should not be prescribed.

Intravenous iron therapy.

Intravenous iron supplements are administered in the form of iron dextran, iron gluconate and iron sucrose.
Benefits of intravenous iron supplementation:

· no problems with gastrointestinal disorders, which occur with oral administration of iron;

· in case of severe iron deficiency, its intravenous administration can significantly reduce the dose of expensive EPO;

· It was shown that intravenous administration of iron sucrose in a dose of 10-20 mg at the end of each hemodialysis session made it possible to maintain the EPO dose at a level of approximately 60 IU/kg/week for a long time.

With intravenous compensation of iron deficiency, the need for erythropoietin is almost 2 times less than when using oral medications(Fig. 14-7).

Rice. 14-7. The need for erythropoietin during oral and intravenous administration iron preparations.
Flaws:

· anaphylactic reactions occur in 1% of cases when treated with iron dextran;

· reported hypotension and epigastric pain with intravenous ferric gluconate;

· with the administration of iron sucrose, cases of chest pain and bronchospasm have been described;

· Absolutely everyone agrees that intravenous iron supplements should be administered very slowly.

For example, J. Silva et al. (1998) administered iron sucrose (Venofer) 20 mg intravenously at the end of each hemodialysis over 10 minutes.
There is literature data on excellent tolerability of intravenous administration of iron hydrosaccharate in doses of 10, 20 and 40 mg. More than 200 patients received 80,000 injections of this drug without side effects.
A.R. Nissenson (Am. J. Kidney Dis. - 1997. - Vol. 30, No. 6. - P. 907-911) gives the following regimen for treating dialysis patients with iron:

1. The goal of treatment is to obtain the desired hematocrit without an excessive dose of EPO to stimulate erythropoiesis.
2. Replenish iron stores if transferrin saturation (TSAT) is less than 20% or ferritin is less than 100 ng/ml by administering 1000 mg parenteral iron. 100 mg for each hemodialysis.

Here we will interrupt the recommendations of Prof. A.R. Nissenson and inform you that, according to the latest data, iron replacement should not exceed 20-100 mg per week. Let us recall that the widely used drug Ferrum-Lek for intravenous administration contains 100 mg of iron in the form of sucrose in 5 ml of solution. And it is better to administer Ferrum-Lek by slow infusion throughout hemodialysis. Estimating iron reserves using Fe++ content alone is unreliable. For example, when treated with erythropoietin, iron levels can quickly and severely decrease and a so-called relative deficiency occurs. Remember that in practical work, ferritin is an indicator of iron reserves in the body - after all, hemoglobin can be examined everywhere (Table 14-3).
Table 14-3. Assessment of iron reserves in the body.

Index	Norm	Relative iron deficiency	Absolute iron deficiency
Plasma iron, mcg%	40-160
Total iron-binding capacity, µg%	250-450
Transferrin saturation, %	20-40	< 20	< 16
Plasma ferritin, ng/ml	Men 13-220 Women 13-125	< 100	< 30

3. Repeat iron tests 2 weeks after the last infusion and repeat treatment if TSAT 20% or ferritin level 100 ng/mL.
4. When TSAT is 20% or ferritin level is 100 ng/mL, begin maintenance therapy with 50 mg parenteral iron once weekly. Next, select the dose so that these indicators are: 20% TSAT 50% or 100 ng/ml ferritin 800 ng/ml.
5. If TSAT 50% or ferritin 800 ng/ml, take a break for 3 months.
6. Monitor the assessment of iron reserves once a quarter and only 2 months after the last iron infusion.

It is believed that the patient's daily requirement for iron is 7-15 mg/day. 25% of patients can take iron supplements orally. There is an opinion that in case of iron deficiency there is no need to force its parenteral administration. The maximum dose is 200 mg per week. The patient will still not absorb more. And we repeat once again: intravenous iron should be administered by slow infusion.

Verdict on iron dextran

I would like to dwell on this topic in particular. This drug is very strongly and specifically criticized by very serious drug control organizations (Faich G., Strobos J. // Am. J. Kidney Dis. - 1999. - Vol. 33, No. 3. - P. 464-470 ). When using iron dextran, severe anaphylactic reactions were observed, sometimes with fatal(Table 14-4).
Table 14-4. Anaphylactic reactions to iron dextran administration in the United States (1993-1996)

Year	Number of reactions	Number of deaths
1993
1994
1995
1996

The overall incidence of allergies and anaphylaxis from iron dextran was compared with the incidence of allergies to sodium ferric gluconate complex in sucrose (Ferrlicit). It turned out that there are practically no side reactions with Ferrlicit (Table 14-5).
Table 14-5. Overall incidence of allergic reactions to iron dextran and sodium ferric gluconate complex in sucrose (Ferrlicit)

A drug	Number of messages	Number of deaths	Exodus unknown	Frequency lethal ness, %
Iron dextran				15,8
Ferrlicit

In the United States, according to USRDS data for 1996, almost half of patients take iron supplements only orally.

Assessment of iron reserves using the Van Wick nomogram

It has been shown that the level of serum transferrin has a practically functional relationship with the percentage of saturation (saturation) of transferrin with iron (in practical work there is no urgent need to determine these indicators).Based on the fact that iron reserves can be assessed only by the content of iron and ferritin, Van Wick et al. (Kidney Int. - 1989. - Vol. 35. - P. 712-716) developed a very simple nomogram for estimating iron reserves.For example, the initial hemoglobin is 8.5 g%, and the ferritin level is 40 μg/L. From the indicated points we construct perpendiculars until they intersect with the nomogram. From the intersection point we draw a straight line parallel to the inclined lines until it intersects with the lower horizontal axis. The resulting point shows that the approximate iron deficiency at this time is about 300 mg.
There is also a simple formula to determine the approximate iron requirement:

Iron requirement (in mg) = 150 (desired Hb g% - actual Hb g%).

Returning to the above example, let's try to determine the approximate iron requirement using the formula, if we take 11 g% as the level of desired hemoglobin:

Iron requirement (in mg) = 150(11-8.5) = 150 2.5 = 375 mg.

The result is similar. But the significance of the Van Wick nomogram is also that it allows you to determine very dangerous condition, which is caused by excess iron and is called hypersideremia, or hemosiderosis.
Let's assume that the patient's hemoglobin is 7.5 g% and ferritin is 2000 mcg/l. On the Van Wick nomogram, the intersection point of these indicators is in the region of supersaturation (surplus) above the inclined line of zero deficit. Therefore, the patient does not need any iron.
Finally, after all of the above measures have been completed, and the hemoglobin level persistently does not increase, you can think about treatment with erythropoietin.

Erythropoietin

Even with perfect hemodialysis, 25% of patients fail to maintain hemoglobin levels at an acceptable level, the lower limit of which is 90 g/l. In such cases, treatment with recombinant human erythropoietin (r-HuEPO) is indicated.
The drug erythropoietin is called recombinant because it is obtained using genetic engineering. Chinese hamster eggs contain a gene that encodes the synthesis of human erythropoietin. These cells begin to produce erythropoietin, indistinguishable from natural human erythropoietin. The molecular weight of erythropoietin is 32,000-40,000 D.
Erythropoietin stimulates the formation of red blood cells from bone marrow stem cell precursors.
Let's start, naturally, with contraindications. There are only 2 of them:
1) uncontrolled hypertension (?);
2) hypersensitivity to any component of the drug.
Uncontrolled hypertension in hemodialysis practice is casuistry. IN last years We have never met such patients. That's why this contraindication does not significantly limit the use of Eprex.
As for hypersensitivity, erythropoietin itself does not cause allergies, since it is completely identical to human erythropoietin. Allergies can be caused by inactive ingredients in erythropoietin.

Dosage

There are 2 phases in treatment with erythropoietin:

1. Hemoglobin level correction phase

The drug is administered subcutaneously or intravenously three times a week. The initial single dose is 30-50 units per 1 kg of weight. For example, for a patient weighing 60 kg, the initial single dose is 3000 units, if we start with 50 units/kg:
50 x 60 = 3000 (IU).For intravenous administration, the average single dose is 2000-4000 units, and for subcutaneous administration, 2000-3000 units. After a month, we check the hemoglobin level and, depending on the result, change the dose.
If the monthly increase in hemoglobin level does not exceed 10 g/l, the single dose should be increased by 20-25 units/kg, which is equivalent to an increase in the weekly dose by 60-75 units/kg. At monthly increase hemoglobin level from 10 to 20 g/l, we leave the single and weekly dose the same. A monthly increase in hemoglobin concentration from 20 to 25 g/l allows you to reduce a single dose by 20-25 IU/kg and, accordingly, a weekly dose by 60-75 IU/kg.
An increase in hemoglobin over 25 g/l within a month requires stopping the administration of erythropoietin.

2. Maintenance phase

The goal of erythropoietin treatment is to maintain hemoglobin at 100-120 g/L.
The average maintenance weekly dose varies depending on the route of administration from 30 to 100 IU/kg. This means that an acceptable hemoglobin level can be achieved by subcutaneously administering only 30 U/kg once a week.
The maximum weekly dose should not exceed 200 units/kg. If the hemoglobin level is more than 130 g/l, the administration of erythropoietin should be suspended until the hemoglobin drops to 120 g/l. Treatment with erythropoietin should be resumed by reducing the dose by 25%. Without erythropoietin, hemoglobin decreases by an average of 5 g/l per week.

According to many experts, with subcutaneous administration of Eprex it is possible to maintain a stable hemoglobin level in smaller doses than with intravenous administration.
The rules for subcutaneous administration of Eprex are presented in Fig. 14-16.

Rice. 14-16. Rules for subcutaneous administration of Eprex in ready-made syringes.

· Inject into the areas indicated in the figure.

· Important: Alternate injection sites are arranged from left to right.

· Disinfect the selected area with a swab soaked in antiseptic.

· Create a skin fold using your thumb and index finger.

· Insert the needle full length perpendicularly into the skin fold.

· Slowly inject the solution by pressing on the pistons while continuing to hold the fold.

· Carefully remove the needle.

· Apply pressure to the injection site for a few seconds using a piece of dry cotton wool.

· after hemodialysis into a peripheral vein slowly over 1-2 minutes;

· into the fistula needle after the end of hemodialysis; in this case, after Eprex, 10 ml of blood should be injected to make sure that all Eprex has gone into circulation; For this purpose, blood can be taken from another fistula needle; Blood from the needle tubes can be forced into the circulation with saline.

The drug cannot be mixed with any other medications and cannot be administered as an infusion.

Side effects

Flu-like symptoms - headache, aching joints, feeling of weakness, dizziness, fatigue - are possible especially at the beginning of treatment.

Precautions

When treating with erythropoietin, it is necessary to monitor patients with ischemic vascular diseases and persons with convulsive syndrome.
During treatment with erythropoietin, intensive utilization of iron occurs, therefore, during treatment, when ferritin decreases to a level below 100 ng/ml or transferrin saturation below 20%, it is recommended to prescribe iron supplements.

Correction of hemodialysis prescription

As hemoglobin levels increase, blood clotting is likely to normalize, so a slight increase in the dose of heparin may be required. Double check your anticoagulation profile.
It is quite natural that with an increase in hematocrit, the volumetric velocity of plasma flow through the hemodialyzer becomes somewhat smaller. Check your hemodialysis prescription so that the effectiveness of hemodialysis does not decrease.In short, erythropoietin only works effectively when hemodialysis is safe, the dialysis dose is adequate, and nutrition is provided.
Other possible reasons insufficient effectiveness of Eprex:

· hyperparathyroidism;

· aluminum intoxication

· infection;

· hemolysis;

· vitamin B deficiency 12 , folic acid, vitamin C;

· immunosuppression;

· hypothyroidism.

Currently, erythropoietin is one of the the most important factors survival of hemodialysis patients.

Erythropoietin is one of the hormones that is responsible for the formation of red blood cells, that is, red blood cells, in the blood. The erythropoietin blood test is prescribed only for diagnosing anemia. In addition, its indicator is necessary for the development tumor process in the circulatory system, which is benign in nature and is the result of an increased number of red blood cells in the blood.

By and large, such a hormone acts as a stimulant, because it provokes the formation of red blood cells. Every day it provokes the appearance of 200 billion red blood cells in the human blood. It is also worth noting that this hormone is not stored in the body in reserve, but is produced in the required quantity every day. Another name for this hormone is cytokine.

Where is erythropoietin produced? It is synthesized by the liver and kidneys. It is noteworthy that the liver accounts for only 10% of the production of this hormone, and the kidneys account for the remaining 90%. That is why the level of this hormone can be very different from the norm in case of kidney problems.

As a rule, an increase in the cells of hormones synthesized by erythropoieton indicates hypoxia, that is, oxygen starvation. U healthy person This disease is accompanied by bleeding. In addition, experts note that the level of this hormone often increases in pregnant women, as well as in patients diagnosed with kidney tumors. If the hormone level is reduced, this indicates renal failure. At the same time, anemia may begin to develop and the hemoglobin concentration may sharply decrease.

Normal level of erythropoietin in the blood

It is worth noting that the analysis of erythropoietin may differ from the norm not only as a result of destabilization of the functioning of the bone marrow, but also due to a deficiency of important microelements in the body. In order to determine the level of this hormone, it is necessary to conduct a blood test. What does an erythropoietin blood test show? Reference values, that is, the rate of erythropoietin should range from 9.6-30 mIU/ml.

It is noteworthy that in women the level of this hormone is always slightly higher. If the concentration of this hormone is very different from the norm, then this indicates ongoing pathological processes in the human body. If erythropoietin is increased and hemoglobin is decreased, this indicates anemia. Otherwise, if anemia is diagnosed, then destabilization of kidney function is most often diagnosed.

Why is erythropoietin elevated?

The amount of this hormone can be either higher or lower required norm, but most often experts diagnose its increased concentration. If the level of erythropoietin is elevated, the reasons for this are the following:

Pathologies in the circulatory system.
Bone marrow disorders, in particular hematopoietic aplasia. This is a fairly rare disease that affects the circulatory system and is characterized by a decrease in the production of red blood cells. The levels of other important cells remain normal.
Chronic or acute blood loss. At such a moment, the body urgently needs red blood cells, which is the result of increased production of the hormone erythropoietin.
Various forms of anemia. Iron deficiency and other forms of anemia are always the cause of increased concentrations of the hormone erythropoietin.
Myelodysplastic syndrome.
Leukemia.

All of the above reasons are directly involved in the human circulatory system, but there are several more kidney diseases, which also result from increased concentrations of the hormone:

Impaired blood supply to the kidneys as a result of shock.
Changes arterial vessels in the kidneys;
Presence of cysts and kidney stones.

In addition, diseases that are characterized by a sharp decrease in oxygen in the blood should not be excluded from the list of reasons for increasing hormone concentrations. This may include Chronical bronchitis, heart defects and others pathological processes in organism.

If the level of the hormone erythropoietin in the blood is increased, the patient may experience the following symptoms:

Headaches and frequent dizziness.
Difficulty breathing even at rest.
Itching all over the body, which is most pronounced after taking a warm shower.
Bleeding or thrombosis of veins and arteries.
The skin becomes purple in color.
The nose and ears become a little blue.
The spleen increases in size.

All of these symptoms of increased levels of the hormone erythropoietin are caused by a sharp increase in the number of red blood cells. As a result, the blood becomes much thicker, which can lead to serious complications, since small vessels become clogged very quickly.

Little known ordinary people the hormone erythropoietin performs vital necessary for a person functions. Secretion of erythropoietin (cytokine) occurs in the kidneys, from where it enters the bone marrow. To clarify, 90% of the hormone is produced by the kidneys, 10% by the liver.

With the help of a hormone based on stem cells, red blood cells are formed, which many have heard about, since its content is often determined in general analysis blood. Red blood cells contain hemoglobin, which is responsible for transporting oxygen in the body.

Every day, the cytokine has to form 200 billion red blood cells, since there is no supply of these cells in the blood and internal organs.

A few words about red blood cells

Red blood cells are important cells found in the blood. Their period of existence is 120 days. All these cells are exactly the same in shape and size. If there are not enough red blood cells in the blood, the human body will lack oxygen. And all internal organs and tissues need it to perform their functions.

A lack of red blood cells occurs as a result of injury after increased blood loss. These cells can also be destroyed by various reasons. In these cases, the brain signals the kidneys to produce erythropoietin, and the hormone initiates the production of new red blood cells.

The described process is very important for athletes, since during heavy physical overload the body spends a lot of oxygen. In people who engage in heavy physical work, the body adjusts to the timely production of erythropoietin. But to supply the organs with a sufficient amount of oxygen, not only red blood cells are needed, it is also necessary to eat iron-containing foods, take vitamin B12 and folic acid.

Erythropoietin, norm and deviations from it

What is it - erythropoietin? The substance is formed from amino acids certain type. It includes 4 glucose fragments, which differ from each other in physical and chemical characteristics. If there is not enough cytokine in the body, the person most likely has kidney problems. It could be renal failure, hormone deficiency also occurs after hemodialysis (extrarenal blood purification).

When the amount of this hormone exceeds the norm, the doctor can make a preliminary diagnosis of kidney disease or other internal organs. Although, an increased rate can be observed in pregnant women, and, in this case, exceeding the norm is not a sign of illness.

Table of hormone content norms:

The hormone is synthesized in the body when there is a lack of oxygen. Once the problem goes away, cytokine secretion stops.

Men have less erythropoietin in their blood because they have more testosterone, which also stimulates the formation of red blood cells. Men require less of the hormone. Women have much less testosterone, but they have estrogen, which inhibits cytokine secretion. Therefore, they produce the described hormone more actively, taking into account the counteraction of estrogen.

Erythropoietin test

To determine the hormone content, blood is taken for analysis. Usually the analysis is combined with clinical analysis blood, in which special attention is paid to the number of red blood cells.

When is a test ordered?

A blood test for erythropoietin is prescribed for patients with renal failure. The study is also carried out during hemodialysis. An increase in hormone levels can be suspected if the following symptoms occur:

Frequent dizziness;
Severe headaches;
Tormenting in horizontal position dyspnea;
Deterioration of vision;
Itchy skin after shower;
Difficult to stop bleeding;
Thrombosis and their consequences (stroke, heart attack);
Blueish skin tone;
Red complexion;
Swelling of the spleen.

These symptoms are a reason to do a hormone test.

Preparing for analysis

Preparation for venous blood collection is standard. The patient is shown:

Do not eat or drink 8 hours before the test, clean water you can drink without gas;
Do not use tobacco in any form the day before or on the day of the test;
Do not take medications the day before or on the day of the test, except those that provide vital functions;
Give up heavy physical work one day before the analysis;
Try to protect yourself from stress the day before the test and in the morning before the test.

Usually, along with a study of the level of erythropoietin, tests are prescribed for the amount of hemoglobin, determination of the volume of folic acid, vitamin B12, hematocrit and erythrocyte indices. The last 2 indicators determine the number of red blood cells in heme. If necessary, other health indicators in the blood are also examined.

When is the amount of erythropoietin increased?

The cause of an increase in hormone levels can be diseases of various organs and systems of the human body:

Circulatory system
- The analysis may indicate a disease in which the number of red blood cells in the bone marrow is reduced, while white blood cells and platelets are within normal limits.
- Also, the level of the hormone may be reduced due to large blood loss.
- Another decrease in this indicator may be caused by various anemias- lack of iron, vitamin B12, folic acid, aplastic anemia (a disease in which hematopoiesis in the bone marrow is reduced, the production of leukocytes, red blood cells and platelets is reduced). This also includes sickle cell anemia and thalassemia, which are expressed in the pathological structure of hemoglobin.
- Stem cell mutations.
- Oncological diseases of the blood.

Kidney diseases
- Disruptions in the blood supply to organs.
- Narrowing renal artery.
- Formation of stones in the kidneys and bladder.
- Multiple kidney cysts.

Diseases resulting from a lack of oxygen in the blood
- Diseases respiratory tract and organs.
- Allergic bronchitis.
- Pneumoconiosis, silicosis (lung diseases that occur when inhaling dusty air and lead to fibrotic processes in the lungs).
- Acquired heart defects, expressed in incomplete closure of the heart valves.
- Heart failure, which occurs due to a lack of oxygen and metabolic disorders in the heart muscle.

Tumor diseases of the nervous system, adrenal glands, kidneys.
Taking the drug erythropoietin as a stimulant (doping) by athletes.

All of the above diseases require additional research- Ultrasound, MRI and so on. You should not diagnose yourself based on one indicator. The doctor will decide what is wrong with you.

Decreased erythropoietin levels

Kidney failure, most often chronic. It is expressed in a decrease in the kidneys’ ability to perform their functions.
Condition after hemodialysis.
Bone marrow proliferation due to active cell division.
Myeloma ( malignant disease).
Rheumatoid arthritis.

The result of the analysis is influenced by the following factors: pregnancy, which increases the indicator; use of anabolic steroids; blood transfusions; reception hormonal drugs.

Kidney failure is sometimes treated with artificially synthesized erythropoietin. But you need to be treated under the supervision of a specialist so as not to harm your health.

Erythropoietin in sports

Athletes know very well what the substance erythropoietin is. In sports it is called EPO. Since hemoglobin, which is part of red blood cells, increases the amount of oxygen transported to the organs and systems of the human body, and erythropoietin stimulates the production of red blood cells, the hormone has been identified as a doping agent. It is clear that an oxygenated body finds it easier to physical exercise. The substance began to be considered a doping after scientists discovered ways to stimulate hormone secretion. In addition, a synthetic drug was obtained.

Doping tests take the athlete's blood or urine. It is easier to determine the presence of this type of doping in the blood. Erythropoietin disintegrates 5–9 hours after entering the body, so 2 days after taking the drug it is difficult to determine the presence of the hormone in the blood. To mask doping, dishonest athletes take heparin. It is an anticoagulant (a drug that prevents blockages blood vessels blood clots).

Proteases are also injected into the bladder through a catheter. The drug breaks down peptide bonds between amino acids. Because erythropoietin is made up of a bunch of amino acids, its presence in the blood is lubricated. WADA (World Anti-Doping Agency) services have learned to determine the use of doping by hormone breakdown products contained in the blood and other signs.

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Erythropoietin

Erythropoietin is a hormone synthesized in the kidneys. It stimulates the formation of red blood cells in the bone marrow.

Synonyms Russian

Epostim, epoetin, recormon, erythropoiesis regulator.

English synonyms

EPO, Erythropoetin.

Research method

Chemiluminescent immunoassay.

Units

mIU/ml (international milliunit per milliliter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

Do not eat for 8 hours before the test (you can drink clean still water).
Stop taking medicines one day before donating blood (in consultation with the doctor).
Avoid physical and emotional stress 30 minutes before the test.
Do not smoke for 30 minutes before the test.

General information about the study

Erythropoietin is a hormone primarily produced in the kidneys. It is released into the bloodstream in response to oxygen deprivation (hypoxia). Erythropoietin enters the bone marrow, where it begins to stimulate the transformation of stem cells into red blood cells. Red blood cells contain hemoglobin, a protein that is capable of carrying oxygen from the lungs to organs and tissues. Normally, the lifespan of red blood cells is about 120 days, they have the same size and shape.

The body tries to maintain approximately the same number of circulating red blood cells. When the balance between the formation and destruction of red blood cells is disturbed, anemia develops. If too few red blood cells are produced in the bone marrow or too many are lost due to blood loss or destruction (hemolysis) caused by abnormal red blood cell size, shape, function, or other causes, the amount of oxygen carried to the organs is reduced. In response, the kidney produces erythropoietin, which is then transported by blood to the bone marrow, where it stimulates the formation of red blood cells.

Red blood cell production is affected by bone marrow function, adequate dietary intake of iron, vitamin B12, and folic acid, as well as the production of erythropoietin and the ability of the bone marrow to respond to appropriate amounts of this hormone.

The production of erythropoietin depends on the severity of oxygen deprivation and the ability of the kidneys to produce the hormone. It is active in the blood for a short time and is then excreted in the urine. Once the number of red blood cells rises after a deficiency, the kidneys begin to produce less erythropoietin. However, if they are damaged and/or cannot create enough erythropoietin, or if the bone marrow does not respond adequately to enough erythropoietin, anemia may develop.

When benign or malignant tumors of the kidneys (or other organs) form, excessive amounts of erythropoietin are produced, resulting in too many red blood cells - polycythemia develops. This leads to an increase in the circulating volume of blood, an increase in its viscosity and blood pressure.

What is the research used for?

To distinguish from each other different kinds anemia and find out how the level of erythropoietin corresponds to the severity of anemia. Need for this study, as a rule, is caused by some abnormalities in the general blood test, which includes determining the number of red blood cells, hemoglobin, hematocrit, and reticulocytes. The results of such an analysis make it possible to confirm the diagnosis of anemia, determine its severity and the cause that caused it.
To find out whether anemia is caused by a lack of erythropoietin or whether this deficiency aggravates existing anemia of another origin.
To assess the ability of the kidneys to produce sufficient amounts of erythropoietin in patients with chronic renal failure.
To find out whether polycythemia is caused by excess production of erythropoietin.

When is the study scheduled?

When the patient's anemia is not explained by iron, vitamin B12 or folic acid deficiency, hemolysis or blood loss.
When red blood cells, hemoglobin and hematocrit are reduced, and reticulocytes are normal or below it.
If necessary, differentiate between the causes of anemia: suppression of bone marrow function and lack of erythropoietin.
When you need to determine how much chronic renal failure affects erythropoietin levels.
If necessary, ensure that polycythemia is not caused by excess production of erythropoietin.

What do the results mean?

Reference values: 4.3 - 29 mIU/ml.

If a patient's erythropoietin level is elevated and at the same time the number of red blood cells is reduced, he suffers from anemia, most likely caused by suppression of bone marrow function. If, with anemia, the level of this hormone is reduced or normal, then, obviously, the kidneys produce insufficient amounts of this hormone.

Increased quantity erythrocytes and erythropoietin with high probability indicates the production of excess erythropoietin (by the kidneys or another organ). If the red blood cell count is increased and erythropoietin is normal or decreased, it is likely that polycythemia is not due to erythropoietin production.

Causes of increased erythropoietin levels

An acceptable increase in erythropoietin is observed in following situations:

iron deficiency anemia,
anemia with very low hemoglobin levels (including aplastic and hemolytic),
myelodysplastic syndrome and other oncological diseases of the bone marrow, leading to inhibition of its function,
consequences of chemotherapy,
increase in red blood cells caused by oxygen starvation (for example, with lung diseases or being on high altitude),
pregnancy.

Inappropriately high erythropoietin levels can be caused by:

kidney cyst,
kidney transplant rejection reaction,
adenocarcinoma of the kidney - a malignant tumor,
pheochromocytoma - a benign tumor manifested by periodic peak rises in blood pressure,
cerebellar tumor,
polycystic kidney disease,
tumors of other organs (ovaries, testicles, breasts, etc.).

Reasons for decreased erythropoietin levels

An acceptable decrease in erythropoietin occurs when:

rheumatoid arthritis,
multiple myeloma.

Causes of excessively low erythropoietin levels:

Primary polycythemia - excess production of red blood cells caused by the proliferation of bone marrow tissue,
bone marrow transplantation 3-4 weeks ago,
chronic renal failure.

What can influence the result?

First of all, it is necessary to remember that erythropoietin levels are highest in the morning. This indicator increases during pregnancy, taking anabolic steroids(they stimulate the function thyroid gland) and administration of erythropoietin preparations.
Blood transfusions, enalapril and increased viscosity blood plasma reduce the level of this hormone.

Important Notes

If anemia is caused by a deficiency of vitamin B12 or iron, it may persist despite normal quantities produced erythropoietin.
Artificially synthesized erythropoietin is used to treat anemia in patients with chronic renal failure, as well as in patients with bone marrow suppression.

Who orders the study?

General practitioner, therapist, hematologist, nephrologist, surgeon.

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What is it and what are the norms of erythropoietin?

Not everyone knows what erythropoietin is, but this indicator has important in the human body, especially an athlete. Erythropoietin is a hormone produced primarily by the kidneys. It appears in the blood when oxygen starvation begins in the human body.

General information

Erythropoietin also enters the bone marrow, where the process of generation of red blood cells, the basis of which are stem cells, is started. It is this blood cell that contains hemoglobin. This is the same protein that has the ability to carry oxygen.

The life span that red blood cells must demonstrate is usually 120 days. They all have the same shape and size. At the same time, human blood contains approximately the same number of these cells on a constant basis, which circulate through the bloodstream. If fewer red blood cells are produced, too many are lost through destruction or blood loss.

In accordance with this, the total volume of oxygen received by internal organs and tissues will be reduced. In response to this process, the above hormone is produced. This hormone is very important for athletes. The fact is that with constant increased physical activity, oxygen starvation is inevitable. Therefore, the hormone is produced in greater quantities to stimulate the bone marrow to produce red blood cells.

Moreover, the production of this blood component depends not only on the functioning of the bone marrow, but also on the presence of sufficient iron, vitamin B12, and folic acid in the body. The education process itself is also very important. If the hormone is reduced, then there will simply be no stimulating effect on the bone marrow.

To determine the hormone and its level, a blood test is prescribed. The reference values demonstrated by a hormone such as erythropoietin should be in the range of 4.3 – 29 mIU/ml. If the analysis shows other indicators, pathology may be present in the human body.

If the hormone is elevated, and the analysis shows a lack of red blood cells, then most likely we are talking about anemia associated with insufficient functionality of the bone marrow type. If the hormone is not increased, but decreased with the same anemia, then we can talk about improper functioning of the kidneys. They are the ones responsible for the production of this component.

When the hormone is elevated along with red blood cells, we can talk about excessive production of erythropoietin by any excretory organ. If only the red blood cell count is increased, with a decrease hormonal levels, then we can conclude that there is no connection between polycythemia and the production of erythropoietin.

Features of the analysis

A blood test to determine hormonal levels is performed to differentiate, diagnose and confirm anemia in its various manifestations. Despite the fact that the name anemia is used for a number of diseases, its different types are not synonymous.

Such analysis helps in determining how serious the level of pathology is. If endogenous erythropoietin shows low levels, then anemia will show progress.

If a person has chronic kidney disease, it is necessary to carry out analysis with enviable regularity. This is necessary to check the kidneys, their ability to produce the hormone in abundance. However, the test is not required when monitoring for anemia. Sometimes this blood test can help identify the reason why more red blood cells are being produced than necessary.

A blood test is performed when the cause of anemia is not a deficiency of vitamins or microelements. It is not needed in case of blood loss or hemolysis. It is also important to perform the analysis if separation of erythropoietin deficiency and bone marrow suppression is considered. An EPO test is also required if the red blood cell count is high.

Deviations towards increase

The amount of the hormone in the blood can be either higher or lower than normal, but the first condition is much more common. The level can increase as a result of blood diseases, tumors and a number of other conditions.

If we consider these categories separately, there are several options in the list of blood diseases. Pure red bone marrow aplasia can increase hormone levels. This disease is rare. Within its framework, the production of only red blood cells is reduced, without problems with leukocytes and platelets.

As a result of acute or chronic blood loss, this condition will also occur. Anemia of the aplastic type, due to a deficiency of iron, folic acid and vitamin B12, can affect it. Should not be excluded from probable causes and leukemia.

Can increase hormone levels following problems with the kidneys: impaired blood supply resulting from shock, renal artery stenosis, urolithiasis or polycystic disease.

A number of diseases characterized by a decrease in the amount of oxygen in the blood should not be ruled out. It could be bronchitis in his chronic form, COPD, pneumoconiosis, heart defects or congestive failure.

If you want to receive correct indicator When analyzing, it is necessary to exclude the use of erythropoietin. By the way, erythropoietin is considered doping in sports.

Reasons for the decline and features of the analysis

There are not many variants of diseases in which the hormone level decreases. That is why such a laboratory result is much less common than an increase. The level of this hormone may decrease as a result kidney diseases. In particular, when it comes to chronic failure or in patients undergoing dialysis.

Also, do not forget about polycythemia vera. It's about about increased proliferation of all cell lineages in the bone marrow. There is no dependence on the level of erythropoietin.

Do not forget that any analysis must be carried out taking into account preparatory activities. The reason for the distortion of the results may be blood transfusion, taking analapril, or increased viscosity of blood plasma. All these processes will lead to a decreased hormone level as a result of the analysis.

Maximum performance hormone levels are observed in the morning, during pregnancy, taking steroids of an anabolic nature, as well as using erythropoietin directly in dosage form.

It is worth emphasizing that normal erythropoietin levels do not always indicate the absence of pathologies. In particular, anemia resulting from a lack of vitamin B12 or iron may persist even when the hormone level has returned to normal.

Only patients with anemia and chronic renal failure should use artificially synthesized hormones. This treatment will also be effective for problems with the functioning of the bone marrow.

Medications

Often, if the body produces insufficient hormones on its own, medications are prescribed to help compensate for its deficiency. One of these is recombinant erythropoietin. Recombinant human erythropoietin is a purified glycoprotein that acts as a growth factor of a hematopoietic nature.

This drug was obtained as a result of the work of genetic engineers. After taking it, it will be upgraded to normal indicators the level of red blood cells, reticulocytes, and the synthesis of hemoglobin in cells will also be stimulated.

This drug prescribed for anemia caused by:

chronic kidney failure;
bone marrow lesions;
a number of chronic diseases.

The instructions for use also contain information about the possibility of using it for newborns who were premature. Therefore, they need anemia prevention. Such a drug can also increase the level of donor blood, which is subsequently used for autotransfusion.

Before use, you must read the instructions, which detail the contraindications. However, the use of the drug should initially only be carried out as prescribed by a doctor. Contraindications include sensitivity to any components, severe hypertension of the anterial type. If we are talking about the need to increase the amount of donor blood, then a history of myocardial infarction or stroke should become a restriction on use.

It is worth noting that this drug has synonyms. One of them is epoetin beta. Epoetin beta is a glycoprotein containing more than 150 amino acids. The drug epoetin beta helps in the formation of red blood cells from progenitor cells that have been partially committed.

The composition of epoetin beta is very close to that of the natural human hormone. Epoetin beta can be administered intravenously or subcutaneously. As a result of the work of epoetin beta, the number of red blood cells, reticulocytes, and hemoglobin indicators increases.

In addition, after taking epoetin beta, you should expect an increase in the rate of iron incorporation into cells. If epoetin beta is used for leukocytic leukemia, the effect should be expected two weeks later in comparison with other patients. Speaking of pharmacokinetics, epoetin beta shows the best results when administered intravenously. We are talking about 15 minutes.

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Functions of erythropoietin in the human body

If a lot of these cells are produced, then most of them are destroyed or lost during blood loss. Along with this process, the volume of oxygen that was received by internal organs and tissues begins to decrease. Through this entire process, erythropoietin is produced.

The role of the hormone

This hormone is of great importance for people involved in sports. With regular physical activity, oxygen starvation occurs, which is why the hormone begins to be produced in large quantities in order for the bone marrow to be activated to create red blood cells.

But the appearance of these cells depends not only on the bone marrow, but also on the required amount of iron, vitamin B12 and folic acid in the body. The process of creating red blood cells is no less important. If erythropoietin is reduced, then the stimulating effect on the bone marrow will also not occur.

To determine the hormone and its level, a blood test is required. Its normal range is from 4.3 to 29 mIU/ml. If the results do not correspond to these coefficients, then there is a disease. If the level of the hormone is elevated, and the test results show a lack of red blood cells, it means that the person has anemia, which is due to insufficient bone marrow performance.

If the hormone erythropoietin is reduced due to anemia, then there is nervous work kidney It is these organs that are responsible for the formation of erythropoietin.

If erythropoietin is elevated with red blood cells, it means that it is secreted by any internal organ. And if only red blood cells are elevated when the hormone level begins to decrease, then polycythemia has no connection with the production of the hormone.

Structure and significance of erythropoietin

One hormone molecule consists of amino acids. If there is an intense decrease in hemoglobin and red blood cells in the blood, then the body lacks androgenic erythropoietin. As a result, a disease called erythropoietin deficiency anemia begins to develop. Previously, there were no drugs to cure this disease, but now experts prescribe recombinant erythropoietin.

Pharmacists obtain this medicine from animal cells; it is similar in composition to a suitable hormone. The biological activity of the resulting substance is absolutely the same as the endogenous hormone. According to scientists, epo is associated with specific erythropoietin-sensitive receptors that are located on cells.

Method for purification of recombinant erythropoietin

If the hormone cannot be produced independently in the required quantity, specialists are required to prescribe medications that will help the body bring this hormone back to normal.

One of these drugs is recombinant. Recombinant human epo is one of the most famous proteins, which is created by various biological and pharmaceutical companies in the world for drug treatment.

This compound is produced by Chinese hamster ovary cells using recombinant DNA technology. One polypeptide chain of recombinant EPO contains more than 165 amino acids, its mass is 24,000 Da, and the mass of the glycosylated protein is 30,400 Da. As for human EPO, it has its own degree of purity, which is 98%.

This drug is prescribed for anemia caused by:

chronic renal failure;
bone marrow damage;
other chronic diseases.

This drug should be thoroughly studied. The instructions for use contain a special section for its use in newborns who were premature. This means that they definitely need anemia prevention.

With the help of this medicine it is possible to increase the level of donor blood that is used for autotransfusion. Particular attention must be paid to contraindications. Before use, be sure to consult a doctor.

Contraindications for use:

hypersensitivity to any component of the drug;
severe hypertension arterial type;
unstable angina;
uncontrolled arterial hypertension;
thromboembolism;
pregnancy and lactation;
impossibility of effective anticoagulant treatment.

As for the dosage and duration of treatment, this is all prescribed only individually. The doctor looks at the type of anemia, the patient’s condition and the characteristics of the pathology. The drug is administered intravenously. At the beginning of treatment, doses should be no more than 50–150 IU per kilogram of weight. The dosage also varies depending on the age of the patient. The hormone should be administered no more than 3 times a week. In case of overdose side effects more strengthened. After completing a course of treatment for about 3 weeks, the result becomes clear and the patient’s condition improves.

Side effects

Side effects are more intense when the dose is increased independently:

If a person uses this drug to increase donor blood, then it is undesirable for use by people who have suffered a heart attack or stroke.

Recombined erythropoietin analogues

In order for the processes of erythropoiesis to be activated, specialists began to use various medications:

To replace a recombinant with another similar drug, consultation with a specialist is required.

Reasons for the external indicator

Processes in which the hormone is elevated:

Iron-deficiency anemia with low hemoglobin;
consequences of chemotherapy;
malignant or benign tumor cerebellum;
kidney transplant rejection;
kidney cyst;
various malignant tumors;
lung disease;
renal failure;
rheumatoid arthritis.

Reasons why this indicator is lowered:

oxygen starvation;
urolithiasis;
polycystic kidney disease;
myeloma;
polycythemia.

Substitute hormone therapy prescribed by a doctor only after in-depth research and thorough diagnosis of the disease.

Analysis

A blood test for erythropoietin is prescribed only if the following diseases are present:

chronic kidney failure;
anemia in people who have kidney failure;
athletes (the use of erythropoietin is equivalent to doping).

Elevated erythropoietin is observed in people who eat severe symptoms:

dizziness and severe headache;
itching after washing;
bleeding;
cyanosis;
enlarged spleen;
purple facial skin;
visual impairment;
shortness of breath in a horizontal position.

This hormone increases due to the large number of red blood cells. They contribute to blood thickening and clogging of small vessels.

If the hormone level is low, the person suffers from the following symptoms:

pale skin;
fatigue;
fatigue;
low hemoglobin;
shortness of breath with minor physical exertion.

Normal level of erythropoietin in human blood

In women, the norm of this hormone is from 11 to 30, and in men from 9.6 to 26.

Important to remember! All laboratories have their own standards for the level of this hormone. It depends on the equipment that is installed there. In the form, when the study results are ready, you can view the column in which the erythropoietin rate will be indicated.

Analysis for erythropoietin is carried out only in combination with the following studies:

general blood test, where the main attention is paid to the number of red blood cells, hemoglobin;
general urine analysis;
renal tests: urea and creatine;
carcinoembryonic antigen;
liver tests: ALT, AST, GGT, alkaline phosphatase, bilirubin;
folic acid;
blood test for reticulocytes;
ferritin;
transferrin;
alpha-fetoprotein;
serum iron;
vitamin B12.

The level of this hormone is determined in order to assess the regulation of hematopoiesis of the erythrocyte germ.

The following factors may affect the test results:

smoking;
decreased estrogens.

Erythropoietin for athletes

This hormone enriches the body with oxygen. Therefore, a person can withstand quite serious physical activity for a long time. After an athlete has received a certain dose of this hormone, he becomes more resilient.

Erythropoietin is more popular in skiing, running, cycling and athletics. Now this drug has become banned and is considered undesirable for increasing endurance for the human body.

If the drug was administered in small doses. You may not notice it, but, nevertheless, it has a completely different chemical formula compared to natural hormone. If the dose of the drug is regularly overestimated, there may be serious consequences that will affect human health. A disturbance in the composition of the blood may occur, leading to oxygen starvation brain.

If a person has chronic kidney disease, erythropoietin levels will be persistently elevated. The specialist, in turn, must control it by regularly submitting necessary tests.

A patient who has all of the above problems must be registered at a dispensary and constantly undergo treatment to avoid recurrences of the disease.

Additional use of this drug must be discussed with your doctor, as well as the dosage.

This hormone is very important for the human body. All its functions must be explained by the attending physician.

Erythropoietin is a hormone synthesized in the kidneys. It stimulates the formation of red blood cells in the bone marrow.

Synonyms Russian

Epostim, epoetin, recormon, erythropoiesis regulator.

English synonyms

EPO, Erythropoetin.

Research method

Chemiluminescent immunoassay.

Units

mIU/ml (international milliunit per milliliter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

Do not eat for 8 hours before the test (you can drink clean still water).
Stop taking medications the day before the test (in consultation with your doctor).
Avoid physical and emotional stress 30 minutes before the test.
Do not smoke for 30 minutes before the test.

General information about the study

The production of red blood cells is influenced by the functioning of the bone marrow, the intake of sufficient amounts of iron, vitamin B 12 and folic acid in food, as well as the formation of erythropoietin and the ability of the bone marrow to respond to appropriate amounts of this hormone.

When benign or malignant tumors of the kidneys (or other organs) form, excessive amounts of erythropoietin are produced, resulting in too many red blood cells - polycythemia develops. This leads to an increase in circulating blood volume, an increase in its viscosity and blood pressure.

What is the research used for?

To distinguish different types of anemia from each other and find out how much the level of erythropoietin corresponds to the severity of anemia. The need for this study, as a rule, is due to some abnormalities in the general blood test, which includes determining the number of red blood cells, hemoglobin, hematocrit, and reticulocytes. The results of such an analysis make it possible to confirm the diagnosis of anemia, determine its severity and the cause that caused it.
To find out whether anemia is caused by a lack of erythropoietin or whether this deficiency aggravates existing anemia of another origin.
To assess the ability of the kidneys to produce sufficient amounts of erythropoietin in patients with chronic renal failure.
To find out whether polycythemia is caused by excess production of erythropoietin.

When is the study scheduled?

When the patient's anemia is not explained by iron, vitamin B 12 or folic acid deficiency, hemolysis or blood loss.
When red blood cells, hemoglobin and hematocrit are reduced, and reticulocytes are normal or below it.
If necessary, differentiate between the causes of anemia: suppression of bone marrow function and lack of erythropoietin.
When you need to determine how much chronic renal failure affects erythropoietin levels.
If necessary, ensure that polycythemia is not caused by excess production of erythropoietin.

What do the results mean?

Reference values: 4.3 - 29 mIU/ml.

An increased number of red blood cells and erythropoietin most likely indicates that excess erythropoietin is being produced (by the kidneys or another organ). If the red blood cell count is increased and erythropoietin is normal or decreased, it is likely that polycythemia is not due to erythropoietin production.

Causes of increased erythropoietin levels

An acceptable increase in erythropoietin is observed in the following situations:

iron deficiency anemia,
anemia with very low hemoglobin levels (including aplastic and hemolytic),
myelodysplastic syndrome and other oncological diseases of the bone marrow, leading to inhibition of its function,
consequences of chemotherapy,
an increase in red blood cells caused by oxygen deprivation (for example, with lung diseases or being at high altitude),
pregnancy.

Inappropriately high erythropoietin levels can be caused by:

kidney cyst,
kidney transplant rejection reaction,
adenocarcinoma of the kidney - a malignant tumor,
pheochromocytoma - a benign tumor manifested by periodic peak rises in blood pressure,
cerebellar tumor,
polycystic kidney disease,
tumors of other organs (ovaries, testicles, breasts, etc.).

Reasons for decreased erythropoietin levels

What is erythropoietin? Erythropoietin is a hormone that enters the bone marrow, where red blood cells appear. Their basis is stem cells. Red blood cells contain hemoglobin. Red blood cells exist for about 4 months. They all have the same shape and size. Each body contains the same number of red blood cells, which move through the bloodstream.

The role of the hormone

This hormone is of great importance for people involved in sports. With regular physical activity, oxygen starvation occurs, which is why the hormone begins to be produced in large quantities so that the bone marrow is activated to create red blood cells.

If the hormone erythropoietin is reduced due to anemia, it means that there is nervous functioning of the kidneys. It is these organs that are responsible for the formation of erythropoietin.

If erythropoietin is elevated with red blood cells, it means that it is secreted by any internal organ. And if only red blood cells are elevated when the hormone level begins to decrease, then polycythemia has no connection with the production of the hormone.

Structure and significance of erythropoietin

Method for purification of recombinant erythropoietin

If the hormone cannot be produced independently in the required quantity, specialists are required to prescribe medications that will help the body bring this hormone back to normal.

One of these drugs is recombinant. Recombinant human epo is one of the most famous proteins, which is created by various biological and pharmaceutical companies in the world for drug treatment.

This drug is prescribed for anemia caused by:

chronic renal failure;
bone marrow damage;
other chronic diseases.

This drug should be thoroughly studied. The instructions for use contain a special section for its use in newborns who were premature. This means that they definitely need anemia prevention.

Contraindications for use:

hypersensitivity to any component of the drug;
severe form of arterial hypertension;
unstable angina;
uncontrolled arterial hypertension;
thromboembolism;
pregnancy and lactation;
impossibility of effective anticoagulant treatment.

As for the dosage and duration of treatment, this is all prescribed only individually. The doctor looks at the type of anemia, the patient’s condition and the characteristics of the pathology. The drug is administered intravenously. At the beginning of treatment, doses should be no more than 50–150 IU per kilogram of weight. The dosage also varies depending on the age of the patient. The hormone should be administered no more than 3 times a week. In case of overdose, the side effects are more intense. After completing a course of treatment for about 3 weeks, the result becomes clear and the patient’s condition improves.

Side effects

Side effects are more intense when the dose is increased independently:

If a person uses this drug to increase donor blood, then it is undesirable for use by people who have suffered a heart attack or stroke.

Recombined erythropoietin analogues

In order for the processes of erythropoiesis to be activated, specialists began to use various medications:

To replace a recombinant drug with another similar drug, consultation with a specialist is required.

Reasons for the external indicator

Processes in which the hormone is elevated:

iron deficiency anemia with low hemoglobin;
consequences of chemotherapy;
malignant or benign tumor of the cerebellum;
kidney transplant rejection;
kidney cyst;
various malignant tumors;
lung disease;
renal failure;
rheumatoid arthritis.

Reasons why this indicator is lowered:

oxygen starvation;
urolithiasis;
polycystic kidney disease;
myeloma;
polycythemia.

Hormone replacement therapy is prescribed by a doctor only after an in-depth study and thorough diagnosis of the disease.

Analysis

A blood test for erythropoietin is prescribed only if the following diseases are present:

chronic kidney failure;
anemia in people who have kidney failure;
athletes (the use of erythropoietin is equivalent to doping).

Elevated erythropoietin is observed in people who have pronounced symptoms:

dizziness and severe headache;
itching after washing;
bleeding;
cyanosis;
enlarged spleen;
purple facial skin;
visual impairment;
shortness of breath in a horizontal position.

This hormone increases due to the large number of red blood cells. They contribute to blood thickening and clogging of small vessels.

If the hormone level is low, the person suffers from the following symptoms:

pale skin;
fatigue;
fatigue;
decreased hemoglobin;
shortness of breath with minor physical exertion.

Normal level of erythropoietin in human blood

In women, the norm of this hormone is from 11 to 30, and in men from 9.6 to 26.

Analysis for erythropoietin is carried out only in combination with the following studies:

general blood test, where the main attention is paid to the number of red blood cells, hemoglobin;
general urine analysis;
renal tests: urea and creatine;
carcinoembryonic antigen;
liver tests: ALT, AST, GGT, alkaline phosphatase, bilirubin;
folic acid;
blood test for reticulocytes;
ferritin;
transferrin;
alpha-fetoprotein;
serum iron;
vitamin B12.

The level of this hormone is determined in order to assess the regulation of hematopoiesis of the erythrocyte germ.

The following factors may affect the test results:

smoking;
decreased estrogens.

Erythropoietin is more popular in skiing, running, cycling and athletics. Now this drug has become banned and is considered undesirable for increasing endurance for the human body.

If the drug was administered in small doses. You may not notice it, but, nevertheless, it has a completely different chemical formula compared to the natural hormone. If the dosage of the drug is regularly overestimated, there may be serious consequences that will affect a person's health. A disturbance in the composition of the blood may occur, which will lead to oxygen starvation of the brain.

If a person has chronic kidney disease, erythropoietin levels will be persistently elevated. The specialist, in turn, must monitor it by regularly taking the necessary tests.

A patient who has all of the above problems must be registered at a dispensary and constantly undergo treatment to avoid recurrences of the disease.

Additional use of this drug must be discussed with your doctor, as well as the dosage.

This hormone is very important for the human body. All its functions must be explained by the attending physician.

Highly active glycoprotein hormone erythropoietin: what it is, the norm of the regulator of erythropoiesis, causes and symptoms of deviations. The importance of erythropoietin in the body and ways to regulate its level

What is erythropoietin?

Chemically, what is erythropoietin (EPO)?

What exactly does erythropoietin (EPO) do?

Is the kidney the only source of erythropoietin?

Why is it important to know the level of erythropoietin in the blood?

How is erythropoietin analyzed?

What are normal erythropoietin levels?

What is abnormal erythropoietin level to report?

Is erythropoietin available as a prescribed medication?

What are the clinical uses of erythropoietin?

Erythropoietin Brief Overview

Treatment with iron supplements

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Normal level of erythropoietin in the blood

Why is erythropoietin elevated?

A few words about red blood cells

Erythropoietin, norm and deviations from it

Erythropoietin test

When is a test ordered?

Preparing for analysis

When is the amount of erythropoietin increased?

Decreased erythropoietin levels

Erythropoietin in sports

Erythropoietin

What is it and what are the norms of erythropoietin?

General information

Features of the analysis

Deviations towards increase

Reasons for the decline and features of the analysis

Medications

Functions of erythropoietin in the human body

The role of the hormone

Structure and significance of erythropoietin

Method for purification of recombinant erythropoietin

Side effects

Recombined erythropoietin analogues

Reasons for the external indicator

Analysis

Normal level of erythropoietin in human blood

Erythropoietin for athletes

The role of the hormone

Structure and significance of erythropoietin

Method for purification of recombinant erythropoietin

Side effects

Recombined erythropoietin analogues

Reasons for the external indicator

Analysis

Normal level of erythropoietin in human blood