Why use erythropoietin rather than blood transfusions for kidney disease?

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Offline Yrger

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Cost analysis of erythropoietin versus blood transfusions for cervical cancer patients receiving chemoradiotherapy.Kavanagh BD, Fischer BA 4th, Segreti EM, Wheelock JB, Boardman C, Roseff SD, Cardinale RM, Benedict SH, Goram AL.
Department of Radiation Oncology, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia, USA.

PURPOSE: Red blood cell (RBC) transfusions or erythropoietin (EPO) can be used to evade the detrimental effects of anemia during radiotherapy, but the economic consequences of selecting either intervention are not well defined. The RBC transfusion needs during chemoradiotherapy for cervix cancer were quantified to allow comparison of RBC transfusion costs with the projected cost of EPO in this setting. METHODS AND MATERIALS: For patients receiving pelvic radiotherapy, weekly cisplatin, and brachytherapy, the RBC units transfused during treatment were tallied. RBC transfusion costs per unit included the blood itself, laboratory fees, and expected value (risk multiplied by cost) of transfusion-related viral illness. EPO costs included the drug itself and supplemental RBC transfusions when hemoglobin was not adequately maintained. An EPO dosage based on reported usage in cervix cancer patients was applied. RESULTS: Transfusions were given for hemoglobin <10 g/dL. Among 12 consecutive patients, 10 needed at least 1 U of RBC before or during treatment, most commonly after the fifth week. A total of 37 U was given during treatment, for an average of 3.1 U/patient. The sum total of the projected average transfusion-related costs was $990, compared with the total projected EPO-related costs of $3869. CONCLUSIONS: Because no proven clinical advantage has been documented for EPO compared with RBC transfusions to maintain hemoglobin during cervix cancer treatment, for most patients, transfusions are an appropriate and appealingly less expensive option.

PMID: 11567818 [PubMed - indexed for MEDLINE]


My wife is on hemodialysis and receives an injection of Recormon 5000 Epoetin beta after every dialysis which is three times a week.


She is also a heart patient and had a double bypass and an angioplasty.


I know that a blood transfusion costs in the hospital where she goes for her medical needs in Philippine pesos 1,300.


The cost of a Recormon 5000 in Philippine pesos is 1,800 more or less.


I think in place of Recormon injections she should just have a blood transfusion every four(?) weeks, that should be a great saving for us.


Doctors tell us that repeated blood transfusions can lead to iron overload which is bad.


But the Recormon 5000 is not doing much good either, her hemo stands at more than 90 but less than 100, and for her it must be 110 at the minimum.


Doctors say that it's all right for her that her hemo is only that high 90+ but 100-.


About iron overload... doctors also prescribe three times daily an iron supplement (FeSO 525 mg), which makes her stool very very black.


My question is how does the body get rid of excess iron, and what can be done by medication to get rid of excess iron in the body?


Does iron overload really occur with a blood transfusion every say four(?) weeks?



« Last Edit: 23/08/2009 12:26:38 by chris »


Offline chris

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These are very good questions, thanks for raising them.

The kidneys are the source of erythropoietin (epo), a chemical messenger that increases the rate of proliferation of red cell (erythrocyte) precursors in the bone marrow. Epo is secreted in response to low oxygen levels in the renal tissue, which the kidney infers as occurring secondary to low red cell count and hence it boosts bone marrow production of these cell types.

When this occurs the bone marrow precursors make their haemoglobin using iron stored within the body by ferritin, a protein molecular cage that prevents the iron from taking part in other (potentially harmful) metabolic processes. When ferritin iron stores run low the body increases the levels of a protein pick-up molecule called transferrin whose job it is to collect iron from digestion and deliver it to ferritin, thus replenishing iron stores.

There is, however, no way for the body to do the reverse process and remove any excess iron. So if someone has frequent blood transfusions, this constitutes the addition of fresh iron (within the haemoglobin in the transfused red cells) to the body, which can eventually overwhelm the capacity of the iron stores. When this happens the iron can accumulate pathologically within different tissues including the liver, where it can cause cirrhosis, and the heart, where it can cause cardiomyopathy. Both of these diseases are also features of a metabolic disease called haemochromatosis, which is caused by an over-active iron scavenging system which picks up too much iron from the diet.

For this reason, where possible it is preferable to use recombinant epo (artificial epo made biotechnologically) because then the body's own iron is used, which reduces the risk of iron overload. The reason for the dietary iron supplement is that if the body then needs iron there's plenty that can be picked up from the intestine. But this will only happen if bodily iron is in short supply. The black stools are a common and normal side effect of dietary iron consumption; it occurs secondary to oxidation by the conditions in the intestine and this is not harmful.

In the context of your wife's anaemia, patients on dialysis can run a lower red cell count because the dialysis process shortens the lifespan of the blood cells; patients with chronic kidney disease can also make too little of their own epo and hence the bone marrow doesn't receive sufficient stimulus to replace the missing cells. However, running a slightly lower level may not be a serious problem for your wife unless she is symptomatic with it - such as suffering breathlessness, poor exercise tolerance, heart failure or angina and so on.

« Last Edit: 23/08/2009 12:32:36 by chris »
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