Erythropoietin: Physiology and clinical applications

Recombinant human erythropoietin (rhEpo) has come of age. Clinical trials have substantiated that the hormone can alleviate transfusion requirements, correct anemia and improve the quality of life in patients with end‐stage renal disease. Epo is also effective in correcting anemia in patients with rheumatoid arthritis, in AIDS patients taking zidovudine and in patients with various malignancies both off and on chemotherapy. Autologous blood donors are able to donate more blood with less of a deficit in red cell mass when receiving Epo, and preliminary studies suggest that Epo may have a role in correcting the anemia of prematurity. The most cost effective and promising role for the hormone, apart from its use in patients with end‐stage kidney disease, is likely to be in the prevention of the need for homologous blood transfusion in a variety of clinical situations such as the perisurgical period, the anemia associated with prematurity, the period following bone marrow transplantation, and in anticipation of various forms of chemotherapy or retroviral therapy.