title: Erythropoietin overdose treated with emergent erythropheresis.
abstract: Erythropoietin (EPO) is commonly used to treat anemias secondary to renal failure, malignancy, and AIDS. Although therapeutic complications are well described, overdose is rare. A 42-y-o man with AIDS confused his instructions for self-administration of interferon and EPO and began injecting himself daily with 10,000 units of EPO for several weeks. He presented with confusion, pain in his abdomen and feet, and a hemoglobin of 23.2 g/dLwith a hematocrit of 77.1%. The patient was treated with iv fluids, phlebotomy and 2 sessions of erythropheresis which removed 898 mL and 640 mL of red blood cells, respectively; his hemoglobin remained between 12-14 g/dL and symptoms resolved. His only sequelae involved skin loss over his toes, which did not require grafting. This rare case of EPO overdose highlights the complications of essential erythrocytosis, with central nervous system, peripheral, and presumed mesenteric ischemia.
authors.affiliation: New York City Poison Control Center, NY 10016, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: Gina
authors.initials: G
authors.lastname: Cobrin
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Howland
mesh_terms: D000163:Acquired Immunodeficiency Syndrome; D000328:Adult; D016238:Cytapheresis / Q000379:methods; D003937:Diagnosis, Differential; D062787:Drug Overdose / Q000175:diagnosis / Q000628:therapy; D004638:Emergency Treatment / Q000379:methods; D004921:Erythropoietin / Q000506:poisoning*; D006801:Humans; D008297:Male; D012514:Sarcoma, Kaposi
chemical_list: D004921:Erythropoietin