Erythropoietin Hormone (EP)

What sample is needed for Erythropoietin Hormone?

1. Take the venous blood.
2. Separate the serum as early as possible.
3. The serum is stable at room temperature.

What are the Indications for erythropoietin (EP)?

1. This test helps to diagnose the cause of anemia.
2. This test also helps to differentiate primary from secondary polycythemia.
3. It detects the recurrence of EP-producing tumors.
4. This can be an indicator for the therapy of EP in patients with renal failure.

What precautions will you take for Erythropoietin Hormone  (EP)?

1. Pregnancy is associated with a raised level.
2. Steroids and birth control pills can increase the level.
3. Blood transfusion gives reduced EP levels.
4. Drugs like ACTH, contraceptive pills, and steroids increase the level.

How will you define Erythropoietin Hormone (EP)?

1. Erythropoietin (EP) is a glycoprotein hormone that regulates erythropoiesis.
2. This is a glycosylated polypeptide of 165 amino acids with a molecular weight of 34 kDa (31,000 daltons; another source says 45).
3. It is the major regulator of erythropoiesis.
4. It has a plasma half-life of  6 to 9 hours.

Discuss the Pathophysiology of Erythropoietin Hormone (EP) and production?

1. EP is produced in:
   1. 90% is made in the peritubular interstitial cells in the inner cortex of the kidneys.
   2. 10% is produced in the liver.
2. EP is the stimulus for the bone marrow to increase RBC cell numbers.
   1. The increased RBC number increases the oxygenation in the kidneys.
   2. So, the stimulus for the EP is reduced.
   3. This feedback mechanism is very sensitive to the oxygen level.

Erythropoietin Hormone Level (EP): Role of Erythropoietin produced by the kidney

Erythropoietin Hormone Level (EP): Erythropoietin’s role in RBC maturation

3. The stimulus for the activation of the above cells is decreased oxygen, the stimulus for Increased EP production.
   1. There is a feedback mechanism that increases oxygen and reduces EP production.

Erythropoietin functions

Erythropoietin level depends upon O2 level

4. EP is inversely related to red blood cell volume and hematocrit.

What is the significance of Erythropoietin Hormone (EP)?

1. EP is given under the following conditions:
   1. Anemia in the case of chemotherapy patients.
   2. Athletes abuse this hormone to improve their oxygen-carrying capacity and improve their performance.

What are the stimuli for Erythropoietin Hormone (EP) production?

1. Low hemoglobin due to bone marrow failure due to  Iron deficiency anemia.
   1. Or low Hb due to increased destruction of RBCs in case of hemolytic anemia.
2. Defective cardiac or pulmonary function.
3. Damage to renal circulation affects O2 delivery to the kidney.
4. EP is high in EP-producing tumors, like renal cell carcinoma and adrenal gland carcinoma.
5. Increased EP level in patients with polycythemia is due to decreased O2 (hypoxemia).

What are the stimuli for low Erythropoietin Hormone (EP)?

1. Patient with renal diseases or nephrectomy (bilateral) has low EP levels.
2. Decreased EP level is seen in a patient with Malignant polycythemia vera.

What is the role of Erythropoietin (EP) in renal failure?

1. EP, as recombinant human erythropoietin, is very effective in treating anemia due to chronic renal failure in patients who are on dialysis.
2. Polycythemia has elevated EP levels.
   1. While malignant polycythemia vera has reduced EP levels.

What is the Normal value of Erythropoietin?

Source 1

• Serum = 5 to 36 mU/L
  • To convert into SI units x 1.0 = U/L

Source 2

• 5 to 35 IU/L.

Another source

• 3 to 20 mIU/L

What are the conditions leading to Increased levels of Erythropoietin Hormone (EP)?

1. Iron deficiency anemia.
2. Megaloblastic anemia.
3. Hemolytic anemia.
4. Myelodysplasia.
5. Chemotherapy.
6. Pregnancy.
7. Secondary polycythemia due to high altitude and COPD.
8. AIDs.
9. Renal cell carcinoma.
10. Pheochromocytoma.
11. Adrenal carcinoma.

What are the conditions leading to markedly increased levels of Erythropoietin Hormone (EP)?

1. Erythropoietin-producing tumors:
   1. Renal adenocarcinoma.
   2. Renal Cyst.
   3. Renal transplant rejection.
   4. Pheochromocytomas.
   5. Polycystic kidney disease.
   6. Sometimes seen in the ovary, adrenal, testicular, breast, and liver carcinoma.

What are the conditions leading to Decreased Erythropoietin Hormone (EP)?

1. Autoimmune disease like rheumatoid arthritis.
2. Multiple myelomas.
3. Malignancies.

What are the conditions leading to markedly decreased Erythropoietin Hormone (EP)?

1. Polycythemia Vera (primary).
2. Autoimmune nephropathy.
3. Renal failure and renal diseases.
4. After bone marrow transplantation.

What are the conditions for Erythropoietin Hormone (EP) therapy?

1. EP is the best drug for treating anemia due to renal diseases.
2. This can be given in end-stage kidney disease.
3. Anemia of chronic diseases like rheumatoid arthritis or malignancies.
4. It is given I/V or subcutaneously 3 to 7 times per week.
   1. Or once every 1 to 2 weeks, depending upon the indication of the patient.

What are the complications of Erythropoietin Hormone (EP) therapy?

1. Increased blood pressure.
2. Local site injection.
3. Increased platelet count.