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Blood, Vol. 96 No. 3 (August 1), 2000:
pp. 823-833
REVIEW ARTICLE
Erythropoietin, iron, and erythropoiesis
Lawrence T. Goodnough,
Barry Skikne, and
Carlo Brugnara
From the Departments of Medicine and Pathology and Immunology,
Washington University School of Medicine, St. Louis, MO; the Department
of Medicine, University of Kansas Medical Center, Kansas City, KS; and
the Departments of Laboratory Medicine and Pathology, Children's
Hospital, Harvard Medical School, Boston, MA.
Recent knowledge gained regarding the relationship between
erythropoietin, iron, and erythropoiesis in patients with blood loss
anemia, with or without recombinant human erythropoietin therapy, has
implications for patient management. Under conditions of significant
blood loss, erythropoietin therapy, or both, iron-restricted erythropoiesis is evident, even in the presence of storage iron and iron oral supplementation. Intravenous iron therapy in renal dialysis patients undergoing erythropoietin therapy can produce hematologic responses with serum ferritin levels up to 400 µg/L, indicating that traditional biochemical markers of storage iron in
patients with anemia caused by chronic disease are unhelpful in the
assessment of iron status. Newer measurements of erythrocyte and
reticulocyte indices using automated counters show promise in the
evaluation of iron-restricted erythropoiesis. Assays for serum
erythropoietin and the transferrin receptor are valuable tools for
clinical research, but their roles in routine clinical practice remain
undefined. The availability of safer intravenous iron
preparations allows for carefully controlled studies of their value
in patients undergoing erythropoietin therapy or experiencing blood loss, or both.
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