Erythropoietin response after correction of severe hypoxaemia due to acute respiratory failure in chronic obstructive pulmonary disease patients

Abstract

In order to determine the initial values and dynamic changes of EPO (erythropoietin) after therapy, 57 consecutively presenting, typical COPD (chronic obstructive pulmonary disease) patients with chronic hypoxia and acute exacerbated serum EPO levels were serially measured. Initial mean EPO levels were slightly above the normal range (41.4 +/- 83.5 units/l), but in the majority of patients the initial EPO levels were significantly reduced. Following the correction of hypoxaemia, mean EPO levels decreased to 14.1 +/- 16.9 units/l (P=0.0093). However, not all COPD patients showed this pattern; in an important subset of patients (36.8%), who had initially lower EPO levels and lower erythrocyte count, EPO levels were significantly increased (by more than 60%; P=0.0028) on the second day of treatment, despite correction of the hypoxaemia. This finding was unexpected and paradoxical when compared with physiological studies addressing the same issue. The data presented support previous reports of variable EPO levels in severely hypoxic COPD patients and suggest that the haematological response is already hampered at an early stage, at the level of EPO production, and much less likely at later steps in the haemopoietic response by failure to respond to elevated EPO levels. Our data are consistent with recent discoveries that the O2 sensing and regulation of EPO production is a complex process in which multiple factors, including cytokines and therapeutic agents, play a role by enhancing or inhibiting the response. We believe that further studies on this clinical condition are complementary to basic physiological research and may help to elucidate the role of cytokines and other individual factors in complex clinical hypoxic situations.

Low Erythropoietin Plasma Levels during Exacerbations of COPD

“…In keeping with this observation, a previous paper in patients with a number of causes of acute respiratory failure, including COPD, pneumonia and heart failure, also reported reduced Epo plasma levels [31]. We propose here that Epo down-regulation during ECOPD can be explained by the burst of inflammation that occurs during these clinical circumstances [32], as shown here by a significant increase in leukocyte and neutrophil counts, as well as by the raised concentration of hsC-RP during ECOPD (table 5).…”

Anaemia in chronic obstructive pulmonary disease: an insight into its prevalence and pathophysiology

“…Following correction of hypoxemia, EPO significantly decreased, but not all patients showed the same pattern; in those with lower initial EPO levels and erythrocyte count, EPO levels significantly increased [81]. In another longitudinal study of 132 severe COPD patients using LTOT who were followed for 3 years, Hb levels decreased significantly among polycythemic patients, but effects in anaemic patients were smaller [82].…”

“…Against this background, Pavlisa et al [81] studied the impact of hypoxemia correction in 57 COPD patients with chronic hypoxemia during AECOPD. Following correction of hypoxemia, EPO significantly decreased, but not all patients showed the same pattern; in those with lower initial EPO levels and erythrocyte count, EPO levels significantly increased [81].…”

Anemia as a comorbidity in chronic obstructive pulmonary disease - A hospital-based study in East Sikkim

“…[20] However, in some other studies, it has been shown that aging is responsible for the greater prevalence of anemia in COPD patients. [17,18,21,22] Even in our study, the maximum male anemic patients were in the age group of 71-80 years (10.6%) followed by 81-90 years (6.3%). However, in the female anemic patients, the trend was slightly different.…”