Erythropoiesis in the anemia of bone marrow failure

Abstract

A B S T R A CT The quantitative relationship between red cell volume, erythropoietin level, and erythropoiesis was evaluated in 43 human beings. Results in normal man were compared with studies in patients with anemia from bone marrow failure and with polycythemia vera. The maximum erythropoietin excretion after bleeding normal men was similar to the basal levels found in patients with chronic anemia of similar magnitude. Although erythropoietin values were low in patients with polycythemia vera, bleeding evoked a normal response. In patients anemic from bone marrow failure, basal levels were elevated, and phlebotomy resulted in an increase consistent with the new level of anemia. These observations indicate that erythropoietin level is affected primarily by the degree of anemia and is not influenced by the duration of anemia. In normal subjects, a fivefold increase in urinary erythropoietin was associated with a doubling of erythropoiesis. Despite similar degrees of erythropoietin production, anemic patients with evidence of bone marrow in the lower extremities had greater red cell production. In patients with polycythemia vera, red cell production was inappropriately elevated with regard to the urinary erythropoietin excretion. Bone marrow maturation time was not shortened in patients anemic from bone marrow failure to the same degree as in bled, normal volunteers. In addition to an adequate level of erythropoietin production, normal bone marrow function is necessary for maximal shortening of maturation time.

Erythropoietin Response to Anaemia in Children with Sickle Cell Disease and Fanconi’s Hypoproliferative Anaemia

“…The inverse relationship between severity of anaemia and serum erythropoietin levels has been re ported previously [5][6][7], Hammond and Keighley [8] demonstrated an inverse relationship between pa tients' haemoglobin concentrations and both serum and urine erythrocyte-stimulating factor. They also reported differences in the level of haemoglobin at which increased erythropoietic activity was exhibited.…”

Oxymetholone in aplastic anaemia

“…There was an excessive deposition of iron in the marrow reticulum cells and erythroblasts without any effective erythropoiesis. Alexanian, Nadell and Alfrey (1972) showed a five-fold increase in the urinary erythropoietin excretion following the administration of oxymetholone but haematological improvement occurred only in cases who had effective erythropoietic areas demonstrated by the marrow cellularity and by pelvic uptake of the "9Fe. In this study, ten out of the eleven patients who responded had some active erythropoietic areas on serial marrow biopsies and six of these had a peripheral reticulocyte count of more than 2% (Table 2).…”

“…Other workers (Bomford and Rhoads, 1941;Mohler and Leavell, 1958) showed a better prognosis associated with the presence of cellular foci in the marrow. Alexanian et al (1972) concluded that patients with markedly depressed erythropoiesis derived no benefit from oxymetholone. In this study, patients with cellular areas on the trephine sections had a better prognosis and appeared more likely to respond to oxymetholone.…”

Guideline for the diagnosis and management of myelofibrosis

“…A number of androgens have been trialled including nandrolone (Gardner & Besa, 1977;Besa et al, 1982), testosterone (Silver et al, 1964;Gardner & Besa, 1977;Besa Guideline et al, 1982), fluoxymesterone (Gardner & Besa, 1977;Brubaker et al, 1982), oxymethalone (Alexanian et al, 1972;Gardner & Besa, 1977;Hast et al, 1978), etiocholanolone (Gardner & Besa, 1977) and danazol (Levy et al, 1996;Cervantes et al, 2000Cervantes et al, , 2005. Response rates to androgen therapy are reported as varying, most frequently between 30% and 60%.…”