title: Chronic occult intra-alveolar hemorrhage: a rare cause of failure to respond to erythropoietin.
abstract: Recombinant human erythropoietin (EPO) is an effective and safe therapy for correction of anemia in end-stage renal disease (ESRD). Clinical trials reported to date suggest that EPO improves anemia in over 90% of hemodialysis patients with anemia (Eschbach 1989). Factors which have been identified that appear to inhibit the effectiveness of EPO are infection [Muirhead N et al. 1990], iron deficiency, hyperparathyroidism, aluminium excess [Casati 1991] and persistent GIT bleeding. The development of reticulocytosis in response to EPO in the absence of a rise in hematocrit should alert the clinician to the possibility of either hemolysis or occult blood loss. We present a case in which, despite the development of a reticulocytosis of 5% in response to EPO and the absence of hemolysis, we had difficulty in identifying the presumed source of blood loss.
authors.affiliation: Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland.
authors.forename: P J
authors.initials: PJ
authors.lastname: Conlon
authors.forename: S
authors.initials: S
authors.lastname: O'Neill
authors.forename: G
authors.initials: G
authors.lastname: O'Neill
authors.forename: F
authors.initials: F
authors.lastname: Kelly
authors.forename: J
authors.initials: J
authors.lastname: Donohoe
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D019867:Anti-Glomerular Basement Membrane Disease / Q000150:complications* / Q000175:diagnosis; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin