Response of erythropoiesis and iron metabolism to recombinant human erythropoietin in intensive care unit patients

Iperen, Charlotte E. van; Gaillard, Carlo A. J. M.; Kraaijenhagen, Rob J.; Braam, Branko G.; Marx, Joannes J.M.; Wiel, A. van de

doi:10.1097/00003246-200008000-00015

Cited by 215 publications

(203 citation statements)

References 27 publications

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“…9 Notable differences between our study and that study may explain the difference in the outcomes. First, patients in our study were on therapy for a significantly shorter period of time.…”

Section: Discussioncontrasting

confidence: 56%

Prospective Randomized Double-Blind Placebo Controlled Trial of Recombinant Human Erythropoietin Administration to Reduce Blood Transfusions in Anemic Pediatric Intensive Care Patients

Chicella

Krueger

2006

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVEThe purpose of this study was to determine if the number of red blood cell (RBC) transfusions anemic pediatric intensive care unit patients receive could be reduced by the prophylactic administration of recombinant human erythropoietin (rHuEPO). METHODS This was a randomized, double-blind placebo controlled trial. Patients were randomized to receive either intravenous rHuEPO 300 units/kg/day or placebo. Both groups received elemental iron 6 mg/kg/day. RESULTS Twenty-seven patients, ages 1 month to 13 years, were enrolled. Baseline hematocrit (Hct), reticulocyte count, and erythropoietin concentration were similar between the two groups. Three patients randomized to rHuEPO received 1 RBC transfusion each, and 4 patients randomized to placebo received 9 transfusions total (P = .68). The end-of-study Hct was not significantly different between the rHuEPO and placebo groups, 30.3 ± 3.6 and 26.8 ± 4.8, respectively (P = .06). Additionally, neither the % Hct change (baseline to final), nor the % reticulocyte change (baseline to final), was statistically different between the two groups. CONCLUSION In this small group of anemic pediatric intensive care unit patients, prophylactic rHuEPO administration did not reduce the number of patients who received RBC transfusions. Furthermore, it did not significantly increase Hct or reticulocyte count when compared to placebo.

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“…9 Notable differences between our study and that study may explain the difference in the outcomes. First, patients in our study were on therapy for a significantly shorter period of time.…”

Section: Discussioncontrasting

confidence: 56%

Prospective Randomized Double-Blind Placebo Controlled Trial of Recombinant Human Erythropoietin Administration to Reduce Blood Transfusions in Anemic Pediatric Intensive Care Patients

Chicella

Krueger

2006

The Journal of Pediatric Pharmacology and Therapeutics

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“…1,[8][9][10][11][12][13][14][15] In an effort to overcome the relative erythropoietin deficiency observed in critically ill patients, recombinant erythropoietin has been used to stimulate erythropoiesis, mitigate anemia and reduce the need for blood transfusions. Early proof-ofconcept studies were generally small and focused on hematologic response as an outcome measure.…”

Section: Resultsmentioning

confidence: 99%

“…All of the studies were published in peer-reviewed, English-language journals and were sponsored by the same parent company. 1,[8][9][10][11][12][13][14][15] Five of the studies were conducted in North America, 1,8,9,12,13 and 4 were conducted in Europe. 10,11,14,15 Of the 9 studies, 4 enrolled more than 100 patients.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Erythropoietin-receptor agonists in critically ill patients: a meta-analysis of randomized controlled trials

Zarychanski¹,

Turgeon²,

McIntyre³

et al. 2007

Canadian Medical Association Journal

104

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“…Soluble TfR is of particular interest in assessing response to recombinant human erythropoietin (rHuEpo) in patients with chronic renal failure [32,33], aplastic anemia [34], pure red cell aplasia [35], thalassemia intermedia [36], cancer [37 -39], myelodysplastic syndrome (MDS) [37,40], rheumatoid arthritis [41], genetic hemochromatosis [42] or in intensive care [43], as well as in normal subjects [44], autologous blood donors [45] and premature infants [46] or after stem cell transplantation [47,48]. Similarly, sTfR levels can be used to monitor how erythropoiesis subside after cessation of rHuEpo therapy [49].…”

Section: Main Characteristicsmentioning

confidence: 99%

Soluble transferrin receptor for the evaluation of erythropoiesis and iron status

Béguin

2003

Clinica Chimica Acta

388

316

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Iron transport in the plasma is carried out by transferrin, which donates iron to cells through its interaction with a specific membrane receptor, the transferrin receptor (TfR). A soluble form of the TfR (sTfR) has been identified in animal and human serum. Soluble TfR is a truncated monomer of tissue receptor, lacking its first 100 amino acids, which circulates in the form of a complex of transferrin and its receptor. The erythroblasts rather than reticulocytes are the main source of serum sTfR. Serum sTfR levels average 5.0 F 1.0 mg/l in normal subjects but the various commercial assays give disparate values because of the lack of an international standard. The most important determinant of sTfR levels appears to be marrow erythropoietic activity which can cause variations up to 8 times below and up to 20 times above average normal values. Soluble TfR levels are decreased in situations characterized by diminished erythropoietic activity, and are increased when erythropoiesis is stimulated by hemolysis or ineffective erythropoiesis. Measurements of sTfR are very helpful to investigate the pathophysiology of anemia, quantitatively evaluating the absolute rate of erythropoiesis and the adequacy of marrow proliferative capacity for any given degree of anemia, and to monitor the erythropoietic response to various forms of therapy, in particular allowing to predict response early when changes in hemoglobin are not yet apparent. Iron status also influences sTfR levels, which are considerably elevated in iron deficiency anemia but remain normal in the anemia of inflammation, and thus may be of considerable help in the differential diagnosis of microcytic anemia. This is particularly useful to identify concomitant iron deficiency in a patient with inflammation because ferritin values are then generally normal. Elevated sTfR levels are also the characteristic feature of functional iron deficiency, a situation defined by tissue iron deficiency despite adequate iron stores. The sTfR/ferritin ratio can thus describe iron availability over a wide range of iron stores. With the exception of chronic lymphocytic leukemia (CLL) and high-grade non-Hodgkin's lymphoma and possibly hepatocellular carcinoma, sTfR levels are not increased in patients with malignancies. We conclude that soluble TfR represents a valuable quantitative assay of marrow erythropoietic activity as well as a marker of tissue iron deficiency. D

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Response of erythropoiesis and iron metabolism to recombinant human erythropoietin in intensive care unit patients

Abstract: Endogenous EPO concentrations are low in critically ill patients. The bone marrow of these patients is able to respond to exogenous epoetin alfa, as shown by elevated concentrations of reticulocytes and serum transferrin receptors.

Cited by 215 publications

References 27 publications

Prospective Randomized Double-Blind Placebo Controlled Trial of Recombinant Human Erythropoietin Administration to Reduce Blood Transfusions in Anemic Pediatric Intensive Care Patients

Prospective Randomized Double-Blind Placebo Controlled Trial of Recombinant Human Erythropoietin Administration to Reduce Blood Transfusions in Anemic Pediatric Intensive Care Patients

Erythropoietin-receptor agonists in critically ill patients: a meta-analysis of randomized controlled trials

Soluble transferrin receptor for the evaluation of erythropoiesis and iron status

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