The effect of intravenous iron on the reticulocyte response to recombinant human erythropoietin

Major, A. L.; Mathez-Loic, Fabien; Rohling, Roman; Gautschi, K; Brugnara, Carlo

doi:10.1046/j.1365-2141.1997.2123031.x

Cited by 60 publications

(53 citation statements)

References 9 publications

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“…107 Reticulocyte number was not affected by intravenous iron administration in healthy humans subjected to a bolus injection of rhEpo (300 U/kg intravenously). 19 However, MCHr and Ret [Hb] were increased in the intravenous iron/rhEpo group compared with the group receiving rhEpo alone. Thus, intravenous iron increases the hemopoietic response to rhEpo in normal subjects, and this therapy is probably practiced by cheating athletes.…”

Section: Rbc Parameters Associated With Esa Dopingmentioning

confidence: 96%

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Blood doping and its detection

Jelkmann

Lundby

2011

Blood

128

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Hemoglobin mass is a key factor for maximal exercise capacity. Some athletes apply prohibited techniques and substances with intent to increase hemoglobin mass and physical performance, and this is often difficult to prove directly. Autologous red blood cell transfusion cannot be traced on reinfusion, and also recombinant erythropoietic proteins are detectable only within a certain timeframe. Novel erythropoietic substances, such as mimetics of erythropoietin (Epo) and activators of the Epo gene, may soon enter the sports scene. In addition, Epo gene transfer maneuvers are imaginable. Effective since December 2009, the World Anti-Doping Agency has therefore implemented “Athlete Biologic Passport Operating Guidelines,” which are based on the monitoring of several parameters for mature red blood cells and reticulocytes. Blood doping may be assumed, when these parameters change in a nonphysiologic way. Hematologists should be familiar with blood doping practices as they may play an important role in evaluating blood profiles of athletes with respect to manipulations, as contrasted with the established diagnosis of clinical disorders and genetic variations.

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Section: Rbc Parameters Associated With Esa Dopingmentioning

confidence: 96%

“…[16][17][18] ESAs are particularly effective in combination with iron supplementation. 19 The administration of iron results in increased ferritin levels in athletes. 20 Ferritin levels more than 1000 g/L have been observed.…”

Section: The Influence Of Epo On Exercise Performancementioning

confidence: 99%

Blood doping and its detection

Jelkmann

Lundby

2011

Blood

128

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“…Healthy individuals with baseline serum ferritin values Ͻ100 g/L produced a sizable fraction of hypochromic, low-CHr reticulocytes when treated with r-HuEPO (11 ). Use of intravenous iron has been shown to abolish the production of hypochromic reticulocytes and increase the amount of Hb contained in the reticulocyte pool (18 ).…”

Section: R-huepo Therapy and Functional Iron Deficiencymentioning

confidence: 99%

Iron Deficiency and Erythropoiesis: New Diagnostic Approaches

2003

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Iron deficiency anemia is one of the most common diseases worldwide. In the majority of cases, the presence of hypochromic microcytic anemia and biochemical evidence for depletion of body iron stores makes the diagnosis relatively straightforward. However, in several clinical conditions, classic biochemical indices such as serum iron, transferrin saturation, and ferritin may not be informative or may not change rapidly enough to reflect transient iron-deficient states (functional iron deficiency), such as the ones that develop during recombinant human erythropoietin (r-HuEPO) therapy. The identification and treatment of iron deficiency in settings such as r-HuEPO therapy, anemia of chronic disease, and iron deficiency of early childhood may be improved by the use of red cell and reticulocyte cellular indices, which reflect in almost real time the development of iron deficiency and the response to iron therapy. In the anemia of chronic disease, measurements of plasma cytokines and iron metabolism regulators such as hepcidin (when available) may be helpful in the characterization of the pathophysiologic basis of this condition. The ratio of serum transferrin receptor (sTfR) to serum ferritin (R/F ratio) has been shown to have excellent performance in estimating body iron stores, but it cannot be used widely because of the lack of standardization for sTfR assays. The combination of hematologic markers such as reticulocyte hemoglobin content, which decreases with iron deficiency, and R/F ratio may allow for a more precise classification of anemias.

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“…The increase in the target hematocrit was supported by a structured review of available clinical literature that gave rise to clinical practice guidelines advocating a hematocrit range from 33 to 36% (4). Because absolute or relative iron deficiency, arising from exhaustion of marrow iron stores and/or the inability to deliver adequate iron stores to support normoblast proliferation and maturation (5)(6)(7)(8)(9)(10), are common causes of inefficiency in EPO response, concomitant clinical practice guideline statements have been developed for iron administration (4).…”

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confidence: 99%

Trends in Anemia Management among US Hemodialysis Patients

Coladonato¹,

Frankenfield²,

Reddan³

et al. 2002

Journal of the American Society of Nephrology

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Abstract. This study was undertaken to describe the relationship between hematocrit (Hct) and changes in the prescribed dose of erythropoietin (EPO) as well as selected patient and process care measures across annual national samples of hemodialysis patients from 1994 to 1998. This study uses the cohorts identified in the ESRD Core Indicators Project, random samples of 6181, 6241, 6364, 6634, and 7660 patients, stratified by ESRD Networks drawn for each year from 1994 to 1998. Patient demographic and clinical information was collected from October to December for each year. Surrogates of iron stores and patterns of iron and EPO administration were profiled from 1996 to 1998. Multivariable stepwise linear regression analyses were performed to adjust for potential confounding variables and to identify independent variables associated with Hct and EPO dose. Mean Hct and EPO dose increased each year from 31.1 Ϯ 5.2% to 34.1 Ϯ 3.7% and from 58.2 Ϯ 41.8 U/kg to 68.2 Ϯ 55.0 U/kg, respectively (P ϭ 0.0001). Increasing Hct was positively associated with male gender, more years on dialysis, older age, higher urea reduction ratio and transferrin saturation, prescription of intravenous iron, and lower ferritin and EPO dose in multivariable models (all P ϭ 0.0001). Male gender, older age, diabetes, higher Hct, and increasing weight, urea reduction ration, and transferrin saturation were associated with lower EPO doses (all P Ͻ 0.01). Conversely, intravenous EPO and iron were associated with higher prescribed EPO doses (all P ϭ 0.0001). Although increasing Hct is associated with decreasing EPO dose at the patient level, the increase in Hct seen across years among the cohorts of hemodialysis patients in the United States has been associated with increasing doses of EPO at the population level.

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The effect of intravenous iron on the reticulocyte response to recombinant human erythropoietin

Cited by 60 publications

References 9 publications

Blood doping and its detection

Blood doping and its detection

Iron Deficiency and Erythropoiesis: New Diagnostic Approaches

Trends in Anemia Management among US Hemodialysis Patients

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