Serum erythropotietin and serum transferrin receptor levels in aplastic anaemia

Abstract

Serum erythropoietin (EPO) and soluble transferrin receptor levels were serially measured in 74 patients with aplastic anaemia (AA). As control groups we investigated healthy controls (n = 24) and patients with iron-deficiency (n = 23) or haemolytic anaemia (n = 16). There was a significant negative correlation of log EPO on haematocrit both in AA patients and in the anaemic control group. However, for the same degree of anaemia, log EPO levels in AA were significantly higher than in iron-deficiency or haemolytic anaemia. EPO levels at diagnosis did not correlate with severity of aplastic anaemia, nor did they predict outcome after immunosuppression. During immunosuppressive treatment of AA with anti-thymocyte globulin and cyclosporine A, EPO levels were significantly lower compared with pre-treatment values without a corresponding change in haematocrit. This impaired EPO response to anaemia during immunosuppression might affect recovery of erythropoiesis. In AA patients, EPO levels declined with haemopoietic recovery. However, compared with normal controls, EPO levels in remission patients were still higher with respect to their haematocrit. Results of this study argue against the model of a simple feedback regulation of EPO via hypoxic anaemia. Our data support the hypothesis that cytokines and the erythropoietic progenitor pool are involved in the regulation of EPO production. The results illustrate that serial measurements of EPO along with therapeutic interventions are necessary to identify patients who might benefit from treatment with exogenous recombinant human EPO.

Soluble transferrin receptor for the evaluation of erythropoiesis and iron status

“…[21] or of iron deficiency anemia with iron [19]; the removal of excess iron by phlebotomy [24]; the response of aplastic anemia to immunosuppressive therapy [25]; the recovery of erythropoiesis after renal transplantation [26]; and the correction of hypersplenism following splenectomy [27]. Evaluation of marrow erythropoietic activity by sTfR is also valuable in patients receiving chronic transfusions.…”

Characterization of the erythropoiesis in myelodysplasia by means of ferrokinetic studies, in vitro erythroid colony formation and soluble transferrin receptor

“…[12][13][14] In addition, the soluble transferrin receptor (sTfR) can be used to study the proliferative capacity of the erythroid lineage in vivo. [15][16][17] Decreased sTfR levels are observed in patients with erythroid hypoplasia as a result of aplastic anemia, chronic renal failure or after intensive chemotherapy. Increased levels are detected in cases with erythroid hyperplasia due to hemolytic anemia and thalassemia.…”

“…Previous studies have demonstrated that soluble transferrin receptor measurement reflects the degree of erythropoiesis. [15][16][17] To study the relevance of the in vivo and in vitro parameters in MDS, 24 RA and five RARS patients were studied with regard to clinical behavior, in vitro erythroid colony formation, ferrokinetic measurement and sTfR.…”

Soluble transferrin receptor in sickle cell diseases: correlation with spleen function

“…19 In situations where erythropoiesis is threatened, such as in aplastic anemia, the sTfR levels are significantly lower than in patients with iron deficiency anemia, hemolytic anemia or in normal individuals. 20 In hemoglobinopathy, an elevation in sTfR levels may result from the high degree of erythrocyte expansion found in this illness. Corroborating this hypothesis is the demonstration of an inverse relationship between sTfR levels and the age of the patients, as well as between sTfR levels and HbF rates.…”