Hepatitis-related hepatic erythropoietin production

Article Abstract:

Erythropoietin is a glucose- and protein-containing hormone that controls the production of red blood cells. It is produced mainly in the kidney and, to a lesser extent, in the liver. Patients with advanced kidney (renal) disease require either transfusions of red blood cells or artificially produced erythropoietin to maintain a sufficient number of red blood cells. The development of hepatitis (inflammation of the liver due to infection or toxic agents) may alleviate symptoms of anemia (decrease in red blood cells) in patients with advanced renal disease. It is not clear whether increased erythropoietin production or another factor is responsible for the improvement. A case is described of a 28-year-old man who had his kidneys surgically removed and was dependent on dialysis, the artificial filtration of the blood. The patient was severely anemic and was also dependent on transfusion. However, he developed erythrocytosis, an abnormal increase in red blood cells during an attack of hepatitis, which was associated with an increased in the blood levels of erythropoietin. Studies have shown that the liver produces increased amounts of erythropoietin in response to injury; this may occur as a result of hepatitis. The type of liver cell that produces the erythropoietin has not been clearly established. The duration of elevated levels of erythropoietin in this patient correlated with the duration of clinical symptoms of hepatitis. The control of erythropoiesis associated with injury to the liver in patients lacking kidneys is not known, but stresses such as hypoxia (low oxygen levels) as a result of heart disease may play a regulatory role. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Injuries, Physiological aspects, Liver, Erythropoiesis, Hepatitis

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Treatment of the anemia of chronic renal failure with subcutaneous recombinant human erythropoietin

Article Abstract:

Chronic kidney failure causes anemia, which is generally due to inadequate synthesis of erythropoietin, a hormone that stimulates blood cell production. Recombinant, or laboratory-synthesized, human erythropoietin (rEPO) recently became available, providing an alternative to transfusions or male sex hormones as treatments for these patients. Intravenously administered rEPO has provided effective therapy for anemic patients with kidney disease, but many disadvantages are associated with intravenous treatments. The effectiveness of rEPO, administered by subcutaneous injection, was studied in 11 anemic patients with chronic kidney failure. (Subcutaneous injections deliver medication under the skin, as opposed to injections into muscle.) The patients did not yet require dialysis. The proportion of blood cells rose significantly in patients treated with rEPO for 12 weeks and was significantly greater than blood cell levels in untreated patients. After an additional 12 weeks, when all patients had received rEPO, there was no difference in blood cell fractions between the two groups. All patients ultimately required iron supplementation; iron is essential for red blood cell synthesis. Two patients who initially received rEPO and one patient who was not treated during the first 12 weeks experienced abrupt declines in kidney function; in patients treated with rEPO, the improvement in blood parameters is thought to affect kidney function. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Dosage and administration, Chronic kidney failure

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Multicenter study of recombinant human erythropoietin in correction of anemia in rheumatoid arthritis

Article Abstract:

Erythropoietin is a hormone that activates the production of red blood cells. It is a alpha-globulin protein produced and released by the kidney and other tissues. It can also be produced artificially in vast amounts by recombinant technology (genetic engineering), and the product is hence called recombinant human erythropoietin. The effectiveness of recombinant erythropoietin in treating anemia, a condition of decreased numbers of red blood cells, was assessed in 17 patients with rheumatoid arthritis, an inflammatory joint disease. The improvement in numbers of red blood cells was determined by measuring the hematocrit, the percentage of total blood volume that consists of red blood cells. Over an eight-week treatment period, recombinant erythropoietin improved blood abnormalities in four of 13 patients. Blood abnormalities persisted in patients who were given a placebo, a substance with no known therapeutic effect. The erythropoietin dose was adjusted in 11 patients to achieve a normal hematocrit of 35 percent in women and 40 percent in men. Treatment with erythropoietin did not alter the patients' capacity to perform activities of daily living or pain level, and did not cause adverse effects. These findings show that recombinant erythropoietin improves anemia in patients with rheumatoid arthritis without causing adverse effects, but does not improve their clinical status. (Consumer Summary produced by Reliance Medical Information, Inc.)

Rheumatoid arthritis

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