Plasma erythropoietin levels in anaemic and non-anaemic patients with chronic liver diseases

Abstract

AIM:To investigate the serum erythropoietin (Epo) levels in patients with chronic liver diseases and to compare to subjects with iron-deficiency anaemia and healthy controls. METHODS:We examined 31 anaemic (ALC) and 22 nonanaemic (NALC) cirrhotic patients, 21 non-anaemic subjects with chronic active hepatitis (CAH), 24 patients with irondeficiency anaemia (ID) and 15 healthy controls. Circulating Epo levels (ELISA; R&D Systems, Europe Ltd, Abingdon, UK) and haemoglobin (Hb) concentration were determined in all subjects. RESULTS:Mean±SD of Epo values was 26.9±10.8 mU/mL in ALC patients, 12.5±8.0 mU/mL in NALC subjects, 11.6±6.3 mU/mL in CAH patients, 56.4±12.7 mU/mL in the cases of ID and 9.3±2.6 mU/mL in controls. No significant difference (P>0.05) was found in Epo levels between controls, CAH and NALC patients. ALC individuals had higher Epo levels (P<0.01) than these groups whereas ID subjects had even higher levels (P<0.001) than patients suffering from ALC. CONCLUSION:Increased Epo values in cirrhotics, are only detectable when haemoglobin was lesser than 12 g/dL. Nevertheless, this rise in value is lower than that observed in anaemic patients with iron-deficiency and appears blunted and inadequate in comparison to the degree of anaemia.Bruno CM, Neri S, Sciacca C, Bertino G, Di Prima P, Cilio D, Pellicano R, Caruso L, Cristaldi R. Plasma erythropoietin levels in anaemic and non-anaemic patients with chronic liver diseases.

Predictive Factors for Anemia Six and Twelve Months After Orthotopic Liver Transplantation

“…Finally, it seems that serum Epo values in cirrhotic patients are only detectable when Hb is Ͻ12 g/dL. This value is lower than that observed in anemic patients with iron deficiency and seems blunted and inadequate compared with the degree of anemia (15).…”

Darbepoetin-α inhibits the perpetuation of necro-inflammation and delays the progression of cholestatic fibrosis in mice

“…However, Siciliano et al 34 suggested an impaired EPO response in patients with liver cirrhosis. Moreover, Bruno et al 35 showed that an increase in Epo in patients with chronic liver diseases is lower than that observed in patients with iron-deficiency anemia and appears blunted and inadequate in comparison to the degree of anemia. The results of this study show that DPO application effectively reduces anemia in mice.…”

A reply to Siciliano et al.

“…However, as also unravelled by our large study, anaemia is certainly a major factor, and not only the current haemoglobin but also bleeding history or disorders predisposed to elevated EPO plasma levels. Siciliano and co-workers -as well as other groupsraise an interesting point in suggesting comparison of the EPO levels of liver disease patients with an Hb-matched anaemic control group, suggesting that EPO levels are not adequately upregulated with respect to the degree of anaemia [3,4]. This finding may have important clinical implications, because it could promote clinical trials for recombinant human EPO in advanced liver cirrhosis.…”