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Background: Iron deficiency Anemia in pregnancy is one of the most common and intractable nutritional problems in the world today. The objective of this study was to investigate the therapeutic efficacy and safety of rHuEPO combined with IV iron sucrose, in the treatment of pregnant women in third trimester with moderate and severe iron deficiency anemia and whether addition of erythropoietin will increase the rate of rise of Hb without compromising on the safety of the therapy.Methods: 60 pregnant women in the third trimester, diagnosed as cases of moderate and severe iron deficiency anemia were enrolled in this study with 30 subjects in each of the 2 groups. Recombinant Erythropoietin 2000 IU s/c and Inj Iron sucrose 100 mg slow intravenously in 100 ml 0.9% NS over 1 hr on alternate days was administered to the case group and the control group was administered only iron sucrose slow IV in the same dose on alternate days till target Hb (11gm%) was reached. Efficacy measures were reticulocyte count, increase in Hb/week, time to target Hb level and need for continued therapy after 4 weeks.Results: In the case group, the increases in Hb were greater after 1 week of treatment and this was found to be significant (P < .01), the median duration of therapy was shorter in the case group (22 versus 34 days), with more patients reaching the target hemoglobin level by 4 weeks as opposed to 7 weeks in the control group. Average rise in Hb/week was much more in the case group. The groups did not differ with respect to maternal and fetal safety parameters.Conclusions: Iron sucrose plus rhEPO is an effective treatment for iron deficiency anemia in pregnancy probably because of a synergistic action, with rhEPO stimulating erythropoiesis and iron sucrose delivering iron for hemoglobin synthesis.
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[Abstract ] Objective The aim of the study was to investigate the effects of recombinant human erythoropoietin (EPO) and bone marrow mesenchymal stem cell (BMSC) transplantation on renal inflammatory response following cardiopulmonary bypass (CPB). Methods Forty sprague-Dawley male rats were randomly divided into five groups (n=8):shame operation group, CPB group, EPO group, BMSC group and EPO +BMSC group.CPB model was built in shame operation group without CPB .The other four groups un-derwent CPB, following by jugular vein infusion of 1.5 ×106 BMSCs after an hour′s 100 L/kg/min bypass .Jugular vein infusion of 3000 IU/kg EPO was done in EPO group , while the combination of EPO with BMSCs was infused in EPO +BMSC group.The same volume of isotonic saline solution was infused via jugular vein in CPB group and shame operation group respectively .Rats were sacrificed at 24 hours after CPB termination .Blood samples were collected for the determi-nation of creatinine(Cr) and urea nitro(BUN) levels.HE staining was applied in the examination of renal tissues .ELISA was used in the determination of serum interleukin 6 (IL-6) and interleukin 10 (IL-10) levels and western blot was taken to test the expressions of tumor necrosis factor (TNF-α) and insulin-like growth factor 1 (IGF-1). Results In CPB group, the levels of Cr, BUN, IL-6 and the expression of TNF-αwere increased, while IL-10 level and of IGF-1 expression were decreased(P<0.05).TNF-αexpression was increased while IGF-1 expression was decreased in renal tissue (P<0.05).HE staining results showed the renal injury in EPO +BM-SC group was significantly lower than those in EPO group , BMSC group and CPB group , along with the decrease in the levels of Cr , BUN, IL-6, the increase in IL-10 level(P<0.05), as well as the decline of TNF-αexpression and the rise of IGF-1 expression(P<0.05). Conclusion The combination of EPO and BMSCs which reduces renal inflammatory response following CPB has protective effects on renal injury following CPB in rats , which is better than single application of EPO or BMSCs .
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Aims: To correct renal anemia, subcutaneous (SC) route of recombinant human erythropoietin (rhuEPO) administration has been associated with increased efficacy and decreased dose requirements, when compared with intravenous (IV) route. The effect of obesity as a potential modifier during rhuEPO administration has not been well explored. Study Design: Single-center, Longitudinal Cohort Study. Place and Duration of Study: University of Mississippi Medical Center Outpatient Dialysis Unit, between February and November of 2009. Methodology: We performed IV to SC rhuEPO conversion for 86 in-center dialysis patients and, following a six-month equilibration period, we monitored outcomes over a period of three months. We obtained baseline demographic parameters, calculated Body Mass Index (BMI) and monitored iron saturation, ferritin, hemoglobin (Hgb) along with rhuEPO requirements. Patients were divided into 3 categories based on BMI [<25 (n=27), 25-35 (n=38), >35 (n= 21) kg/m2]. Results are reported either as percents, means with SD or median with 25-75% interquartile range, as appropriate. Results: The cohort was all African-American, 48.8% male, aged 54.7 (13.3) years and BMI calculated at 29.9 (7.4) kg/m2. Baseline iron saturation was 24 (10.6)%, ferritin measured 641 (277) ng/mL. Hgb remained unchanged during the observation period: 11.1 (1.3) vs. 11.2 (1.3) gm/dL. Initial rhuEPO weekly dose for the entire cohort was 19,729 (17,448) Units/week (U/week); final dose 17,482 (14,860) U/week, with close correlation between initial and final doses (r: 0.653, P<0.0001). Weekly rhuEPO dose remained virtually unchanged in BMI categories 1 and 2 [13,927 (10,938) vs. 13,297 (10,247) U/week; 20,684 (15,788) vs. 20,997 (17.917)] (P=NS for both) but decreased in the category 3: 25,459 (24,403) vs. 16,444 (12,749) (P=0.081). However, BMI had no independent effect in linear regression modeling with multiple covariates (age, BMI, iron saturation, ferritin) included. Conclusion: Obesity may affect relative efficacy of rhuEPO conversion; additional studies may be needed.
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Introducción: la eritropoyetina alfa recombinante forma parte del tratamiento de la anemia de la prematuridad. En Cuba su uso ha sido limitado y controvertido en cuanto a esquema y dosis empleada. Métodos: ensayo clínico prospectivo, multicéntrico, no aleatorizado, de eficacia y seguridad de eritropoyetina en la disminución de transfusiones en el recién nacido pretérmino de muy bajo peso. Se incluyeron 72 neonatos con edad gestacional menor de 34 semanas posmenstruales, y peso al nacer menor o igual a 1 500 g, con más de 7 días posnatales e ingesta de 50 mL/kg/día. Resultados: todos recibieron eritropoyetina 300 U/kg, subcutánea, 3 veces/semana, hasta las 40 semanas de edad gestacional y suplemento de hierro y vitaminas. La eritropoyetina fue muy segura, solo se notificó con relación posible una retinopatía de la prematuridad, ligera y recuperada. Conclusiones: se transfundieron 7 pacientes (9,7 por ciento) en el curso del estudio. El uso tardío de eritropoyetina en el pretérmino de muy bajo peso confirma su eficacia y seguridad
Introduction: recombinant alpha erythropoietin is part of the treatment for anemia of prematurity. The use of this one in Cuba has been restricted and controversial as to schedule and dose. Methods: prospective, non-randomized multicenter assay on the safety and efficacy of erythropoietin in the reduction of blood transfusion in very-low-weight preterm newborn. Seventy two neonates with gestational age under 34 post-menstruation weeks, weighing equal or less than 1 500 g, over 7 days of life after birth and fed on 50 mL/kg/day were included in the study. Results: all of them received 300 U/kg erythropoietin by subcutaneous administration three times a week up to reaching 40 weeks of gestational age and an iron and vitamin supplement. Erythropoietin is very safe; it was just possibly related to slight retinopathy of prematurity, but overcome. Conclusions: seven patients were transfused (9.7 percent ) in the course of study. The late use of erythropoietin in very-low-weight preterm child confirms its efficacy and safety
Subject(s)
Humans , Male , Female , Infant, Newborn , Anemia, Neonatal/prevention & control , Anemia, Neonatal/drug therapy , Erythropoietin/therapeutic use , Infant, Premature/blood , Multicenter Studies as Topic , Prospective StudiesABSTRACT
Las interacciones entre el corazón y el riñón se han convertido en un área de considerable interés, dada la interdependencia de los mismos. Esto motivó la definición y conceptualización del síndrome cardio-renal anémico, que incluye interacciones bidireccionales, donde alteraciones, tanto agudas como crónicas de cualquier órgano, pueden afectar indistintamente la función renal o la ventricular. El tratamiento, involucra el bloqueo del eje renina angiotensina aldosterona y durante una descompensación aguda es válido el soporte dialítico para control de la volemia. La anemia, es multifactorial, se debe tratar de manera oportuna con hierro endovenoso y eritropoyetina recombinante, reduciendo al mínimo el soporte transfusional. El manejo, la definición y el pronóstico del síndrome cardio-renal anémico aún sigue siendo controversial y es un reto para el internista moderno (Acta Med Colomb 2011; 36: 141-144).
The interactions between the heart and the kidney have become an area of considerable interest, given their interdependence. This led to the definition and conceptualization of cardio-renal anemic syndrome, which includes a bidirectional interaction: acute or chronic injuries of any organ indiscriminately affect renal or ventricular function. Treatment involves blocking the rennin-angiotensin-aldosterone axis and, during acute decompensation, dialytic support for volemic control. Anemia is due to multiple causesand must be treated promptly with intravenous iron and recombinant erythropoietin, to minimize the need for transfusions. Management, definition and prognosis of cardio-renal anemic syndrome are still controversial and represent a challenge for the modern internist (Acta Med Colomb 2011; 36: 141-144).
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Recently, the population of patients who refuse transfusion has increased for both religious and non-religious reasons, even in life threatening emergency situations. Their refusal has highlighted the need to develop nonblood transfusion surgery techniques to decrease the risk from blood transfusions. A 57-year woman with an ulcerative lesion on the gingiva of the right upper molar area visited the department of oral and maxillofacial surgery in Dankook University Dental Hospital. After a preliminary evaluation, the patient was diagnosed with squamous cell carcinoma. As she refused blood transfusion during surgery for religious reasons, surgery was planned using recombinant human erythropoietin (rHuEPO) without a blood transfusion. The patient underwent a partial maxillectomy, supraomohyoid neck dissection, free radial forearm flap and split thickness skin graft under general anesthesia. rHuEPO and iron were used before and after surgery. The hemoglobin/hematocrit (Hb/Hct) level, iron (Fe) and total iron-binding capacity (TIBC) were assessed. The patient recovered completely without any blood transfusions. rHuEPO is a viable alternative for patients with religious objections to receiving blood transfusions.
Subject(s)
Female , Humans , Anesthesia, General , Blood Transfusion , Carcinoma, Squamous Cell , Disulfiram , Emergencies , Erythropoietin , Forearm , Gingiva , Iron , Molar , Mouth Neoplasms , Neck Dissection , Skin , Surgery, Oral , Transplants , UlcerABSTRACT
Objective: To study the influence of recombinant human erythropoietin (rhEPO) preconditioning on the liver function and expression of nuclear factor-κB (NF-κB) during early stage following liver transplantation, and to investigate the possible mechanism of rhEPO preconditioning on ischemia-reperfusion injury after liver transplantation. Methods: Twenty-six patients with advanced hepatic cirrhosis were randomly divided into two groups(n= 13) : the rhEPo pre-treatment group received subcutaneous injection of rhEPO 100 U/kg at 1, 3 and 5 d before liver transplantation, and the control group received 2 ml normal saline in the same manner. The peripheral blood samples were harvested at 1, 2, 4 and 6 h after blood supply recovery in the donator liver to examine the hepatic functions. The NF-κB p65 expression in the peripheral blood samples were examined by Western blotting analysis, the TNF-α level in the blood was detected by ABC enzyme linked immunosorbent assay. Serum ALT and AST were also determined. Results: The liver function indices and the levels of serum NF-κB p65, TNF-α in the rhEPO pretreatment group were significantly lower than those in the control group (P<0.05). Conclusion: Pre-treatment with rhEPO can inhibit hepatic inflammation early after liver transplantation, protecting hepatic function and reducing ischemia-reperfusion injury after liver transplantation.
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OBJECTIVE:To observe the effects and side effects of recombinant erytropoietin(rEPO)on patients with anemia in chronic renal failure(CRF).METHODS:128 patients with anemia in CRF had been given rEPO by subcutaneous injection for12weeks,the clinical effects were observed by own control method.RESULTS:Excellence cases amounted 91,efficacy cases33,and the overall efficacy rate was96.88%;The side effects included hypertension,coagulation in dialysis machine,pain in injection site and head,no severe adverse drug reactions were found;No degradation in renal function was found in non-dialysis patients during the medication.CONCLUSIONS:rEPO could improve anemia in CRF safely and effectively.
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Recombinant human erythropoietin(rHuEPO) therapy has been associated with new onset or exacerbated hypertension. But there are debates on the mechanism for the new onset or exacerbated hypertension after rHuEPO. We have studied the effects of rHuEPO on intradialytic changes in plasma concentration of vasoactive substances. The plasma concentrations of vasoactive substances were investigated before and after hemodialysis in 15 nondiabetic patients with chronic renal failure. The hemodialysis were performed for 210 to 300min by using bicarbonate dialysate. A hemophan dialyzer was used. Blood pressure were measured every 30 min by using Centrysystem(R)3 BP monitor. Patients were grouped into two groups; one was EPO group treated with rHuEPO(n=7, 4000-6000U/week for more than 3 months) and the other was Non-EPO group (n=8, treated without rHuEPO). beta-endorphin, motilin and mean arterial blood pressure(MABP) were unchanged in the EPO group. In contrast, in the Non-EPO group, an increase in beta-endorphin(154.4 +/- 46.3 to 208.3 +/- 68.1pg/mL, p < 0.05) and a decrease in motilin(221.1 +/- 43.1 to 70.6 +/- 7.1pg/mL, p < 0.05) occurred. MABP decreased gradually until 3 hours after start of hemodialysis in these groups. Arginine vasopressin decreased in both groups. But angiotensin II, endothelin-1 and atrial natriuretic peptide were unchanged in both groups. These results indicate that rHuEPO administration have effects on the intradialytic changes in plasma concentration of vasodialtors during bicarbonate hemodialysis. Moreover, the above results suggest that rHuEPO administration may have effects on hemodynamic stability and gastrointestinal function during bicarbonate hemodialysis.