Erythropoiesis, erythropoietin, and iron

Finch, C. A.

doi:10.1182/blood.v60.6.1241.1241

Cited by 120 publications

(35 citation statements)

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“…Accumulated evidence from studies of the impact of anaemia on radiosensitivity, suggest that the optimal haemoglobin concentration is in the range 12-15 g/dl (Dunst, 2000). This value agrees well with extensive evidence of significant changes in cardiac, cognitive and metabolic functions below this level (Besarab et al, 1999;Daneryd, 2002;Cella et al, 2004) and the observation that the plasma erythropoietin level starts to increase when the haemoglobin concentration drops below 12 g/dl, suggesting that this level serves as a physiological checkpoint for tissue hypoxia (Finch, 1982).…”

Section: Optimal Haemoglobin Concentration In Cancer Patientssupporting

confidence: 89%

The impact of anaemia on outcome in cancer

Clarke

Pallister²

2005

Clin Lab Haematol

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Anaemia is not an inconsequential side effect of cancer and its treatment should not be ignored. Current practice for anaemia management varies and its role in influencing outcome in cancer patients is under recognized. As a common complication of cancer, anaemia is prevalent in virtually all tumour types to varying degrees. Predictive factors for anaemia include baseline haemoglobin concentration, decrease in haemoglobin concentration within the first month of treatment, tumour type, duration of treatment and prior blood transfusions. Interest in the prognostic significance of anaemia in cancer patients has generated extensive clinical research. Data is now published in a wide range of tumour types confirming that anaemia is a negative prognostic indicator of outcome (e.g. survival, disease-free recurrence and local relapse), with the strongest association in patients receiving radiotherapy. The association has also been documented in patients undergoing chemotherapy and chemoradiation. A retrospective meta-analysis has shown an overall 65% increased risk of death associated with anaemia in cancer patients. The impact of anaemia as an independent prognostic factor for outcome may be mediated by several factors, however the emerging consensus is on the central role of tumour hypoxia. It has been nearly 50 years since R. Thomlinson and L. Gray (British Journal of Cancer 1955, 9: 539) first documented the existence of hypoxia in tumours and it is now well accepted that tumour hypoxia protects tumour cells from therapeutic damage directly by reducing the availability of oxygen-free radicals which are necessary for optimal impact of radiotherapy, certain chemotherapeutic agents and photodynamic therapy. The indirect effects include the impact of hypoxia on gene expression, which affects genetic stability, proliferation kinetics and cellular metabolism. There has been an emergence of preclinical and circumstantial data over recent years that are suggestive of the ability to correct the negative effect of anaemia on outcome by the use of repeated blood transfusions or recombinant human erythropoietin. This has led to some attempts to measure the impact on survival in cancer patients of treating anaemia, but early attempts have served to underline the complexity of the relationship and have produced unexpected results.

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Section: Optimal Haemoglobin Concentration In Cancer Patientssupporting

confidence: 89%

The impact of anaemia on outcome in cancer

Clarke

Pallister²

2005

Clin Lab Haematol

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“…The 39 to 48 percent expansion of RBC volume represents a threeto fourfold increase in RBC volume. 13 This fourfold increase in erythropoietic activity is accompanied by declining reticulocyte counts and the appearance of hypochromic RBCs by the second week of EPO therapy. 28,29 In a study of escalating (fourfold) increases in EPO dose administered to patients undergoing aggressive phlebotomy, the marrow erythropoietic index increased from 2.9 times (with endogenous EPO stimulation) to 3.6 times over basal rates of erythropoiesis, representing only a 58 percent increase in erythropoiesis.…”

Section: Iron-restricted Erythropoiesismentioning

confidence: 99%

“…Twenty years ago, Finch 13 summarized knowledge gained primarily from studies of normal individuals, patients with hereditary hemolytic anemias, and patients with hemochromatosis. Under conditions of basal erythropoiesis in normal subjects, plasma iron turnover (as an index of marrow erythropoietic response) is little affected, whether transferrin saturation ranges from very low to very high levels.…”

Section: Iron-restricted Erythropoiesismentioning

confidence: 99%

The role of intravenous iron in anemia management and transfusion avoidance

Auerbach¹,

Goodnough²,

Picard³

et al. 2008

Transfusion

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“…12 There is a functional iron deficiency as described by Finch. 34 Intravenous (IV) iron therapy may compensate for iron-restricted erythropoiesis. A reduction in the required rHuEPO dose with concomitant use of IV iron was demonstrated in patients with renal anemia.…”

Section: Iron Deficiencymentioning

confidence: 99%

Recombinant human erythropoietin and management of anemia in orthopedic surgery

Couvret

2006

Transfus Alt Transfus Med

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SUMMARY Concerns regarding the safety, supply and cost of allogeneic blood transfusion have led to the development of recombinant human erythropoietin (rHuEPO) for anemic patients. rHuEPO safely increases preoperative red blood cell production and reduces allogeneic transfusion. During the preoperative period, expected blood loss and patient medical status need to be evaluated to select those patients who can benefit from this therapy. The appropriate dose of rHuEPO is determined according to the patient’s baseline hematocrit. This therapy must be part of an overall management strategy for anemia with appropriate iron supplementation. rHuEPO is used in combination with other blood‐conservation techniques in revision arthroplasties and spine surgery, depending on expected blood loss. The benefits, risks and costs of these blood‐conservation techniques must be compared with those of allogeneic transfusion. For the future, the use of rHuEPO must continue to be developed in anemic patients undergoing orthopedic surgery.

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Erythropoiesis, erythropoietin, and iron

Abstract: Most of the references quoted are from the work of research fellows over the past 30 yr. This topic was chosen in order to acknowledge their outstanding contributions and to express my personal gratitude for the privilege of working with them.

Cited by 120 publications

References 0 publications

The impact of anaemia on outcome in cancer

The impact of anaemia on outcome in cancer

The role of intravenous iron in anemia management and transfusion avoidance

Recombinant human erythropoietin and management of anemia in orthopedic surgery

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