title: Novel uses for recombinant erythropoietin therapy in unlicensed indications.
abstract: Clinical uses for recombinant human erythropoietin (rHuEPO) therapy continue to expand. Initial use was in anaemia associated with end-stage renal disease, but more recently there have been many reports of the benefits of erythropoietin in other clinical situations such as cancer-related anaemia. Recombinant erythropoietin reduces the need for blood transfusion and hence exposure to donor blood products as well as improving quality of life. We report four patients who were transfusion dependent, none of whom had licensed indications for the use of recombinant erythropoietin. Two patients had microangiopathic haemolytic anaemia secondary to mechanical valve haemolysis and were unsuitable for any further cardiac intervention. One patient had anaemia of chronic disease and anti-Vel red cell antibodies, making compatible blood transfusions difficult to obtain. The fourth patient had primary thrombocythaemia and developed transfusion-dependent anaemia secondary to myelosuppressive agents. All four patients had a relative deficiency in endogenous erythropoietin levels ranging between 7 and 41 IU/l. After commencing recombinant erythropoietin therapy, all had a response in haemoglobin of at least 1 g/dl with an overall improvement in their quality of life. We conclude that rHuEPO is a very convenient and useful form of treatment in transfusion-dependent anaemia and in some cases beyond the licensed indications.
authors.affiliation: Department of Haematology, Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland. cmacartney@doctors.org.uk
authors.forename: Christine A
authors.initials: CA
authors.lastname: Macartney
authors.forename: A A Jennifer
authors.initials: AA
authors.lastname: Adgey
authors.forename: Frank G C
authors.initials: FG
authors.lastname: Jones
authors.forename: Treen C M
authors.initials: TC
authors.lastname: Morris
authors.forename: Mary-Frances
authors.initials: MF
authors.lastname: McMullin
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy* / Q000209:etiology; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001789:Blood Group Antigens; D017277:Drug Approval; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006461:Hemolysis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D011994:Recombinant Proteins; D065227:Transfusion Reaction
chemical_list: D000970:Antineoplastic Agents; D001789:Blood Group Antigens; D011994:Recombinant Proteins; D004921:Erythropoietin