title: Estimation of effective and total erythropoiesis in myelodysplasia using serum transferrin receptor and erythropoietin concentrations, with automated reticulocyte parameters.
abstract: The erythroid abnormality in patients with myelodysplasia (MDS) is multifactorial, with ineffective erythropoiesis and poor in vitro progenitor response to erythropoietin (EPO). Serum EPO concentration is variable among patients for a given haemoglobin concentration. We studied 19 non-transfusion-dependent patients with MDS, and 13 healthy elderly control subjects in an attempt to define the factors governing variability in serum EPO and to further characterise the anaemia of MDS. Serum EPO concentration was appropriate for the degree of anaemia in 15/19 MDS patients, and was positively related to mean cell volume (MCV), mean cell haemoglobin (MCH), and percentage highly fluorescent reticulocytes (% HFR), but not to absolute or percentage reticulocyte count. Although the observed/predicted ratio for serum transferrin receptor (TfR) concentration was low in 12 of 19 MDS subjects, no relationship to haemoglobin concentration, reticulocytes or serum EPO was seen. Serum TfR was positively correlated with WBC and platelet counts. Serum TfR was higher in patients with sideroblastic anaemia than refractory anaemia. Standardized in vivo p50 was positively correlated to red cell 2,3 diphosphoglycerate concentration, although this was not the only factor influencing the oxygen dissociation curve. We conclude that effective erythroid output responsive to endogenous EPO drive in MDS is positively related to MCV, MCH and % HFR. Serum TfR may not represent effective output as precisely as % HFR, but may be proportional to total marrow erythropoietic activity.
authors.affiliation: Department of Haematology, University Hospital of Wales, Cardiff, UK.
authors.forename: D T
authors.initials: DT
authors.lastname: Bowen
authors.forename: D
authors.initials: D
authors.lastname: Culligan
authors.forename: Y
authors.initials: Y
authors.lastname: Beguin
authors.forename: R
authors.initials: R
authors.lastname: Kendall
authors.forename: N
authors.initials: N
authors.lastname: Willis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport; D004920:Erythropoiesis / Q000502:physiology*; D004921:Erythropoietin / Q000097:blood* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000097:blood*; D010100:Oxygen / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011990:Receptors, Transferrin / Q000378:metabolism*; D011994:Recombinant Proteins / Q000097:blood / Q000627:therapeutic use; D017701:Reticulocyte Count; D012156:Reticulocytes / Q000166:cytology / Q000502:physiology*
chemical_list: D011990:Receptors, Transferrin; D011994:Recombinant Proteins; D004921:Erythropoietin; D010100:Oxygen