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Is it advisable to use of epo for sickle-cell patient that can not have blood transfusion?

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asked Jun 29, 2012 in Conditions and Treatments by anonymous
edited Jun 29, 2012 by LarryEitel

1 Answer

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"Hematologic responses, detailed herein, suggest that EPO therapy may allow more aggressive HU dosing in high-risk SCD patients and in the setting of mild renal insufficiency, common to the aging sickle cell population. Furthermore EPO appears to be safe in SCD, particularly when used in conjunction with HU."
 
 
Haematologica. 2006 Aug;91(8):1076-83.

Combination erythropoietin-hydroxyurea therapy in sickle cell disease: experience from the National Institutes of Health and a literature review.

Little JA, McGowan VR, Kato GJ, Partovi KS, Feld JJ, Maric I, Martyr S, Taylor JG 6th, Machado RF, Heller T, Castro O, Gladwin MT.

Source

Vascular Medicine Branch, National Heart Lung and Blood Institute, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1476, USA. janelittle@mail.nih.gov

Abstract

Erythropoietin is being used more widely in the management of sickle cell disease (SCD, inclusive of homozygous sickle beta, SS, and compound heterozygous sickle beta thalassemia, Sbeta0 thal), often in conjunction with hydroxyurea (HU). Herein, we summarize the published experience with erythropoietin use in SCD, in 39 patients (SS, n = 30; Sb0 thal, n = 9) who were treated between 1990 and 1996; and in 13 patients with sickle syndromes (SS, n = 12, compound heterozygous SC disease, n = 1) who were treated with erythropoietin or darbepoietin at the National Institutes of Health (NIH) since 2002. The dose range of erythropoietin for SCD in the published series, at a median of > 200 U/Kg/dose, is higher than that used in end-stage renal disease. The median duration of erythropoietin therapy was > or =3 months, with minimal reported side-effects. At the NIH, the median age of sickle syndrome patients who received erythropoietin or darbepoietin (both referred to as EPO in the NIH series) was 51 (24 to 70) years; 12/13 patients had sickle-associated pulmonary hypertension. Eleven out of the 13 patients were treated with both HU and EPO for > 4 months (median of 11 months on EPO) without complication. Of the 13 patients, five (all SS) with pulmonary hypertension were given EPO for reticulocytopenia (< 100,000/mL) on HU; 5/13 patients (all SS), with pulmonary hypertension, were given EPO and HU concurrently, in the light of an estimated glomerular filtration rate of < 80 mL/minute. Three of the 13 patients (2 SS, 1 SC) were treated with EPO for miscellaneous reasons. Hematologic responses, detailed herein, suggest that EPO therapy may allow more aggressive HU dosing in high-risk SCD patients and in the setting of mild renal insufficiency, common to the aging sickle cell population. Furthermore EPO appears to be safe in SCD, particularly when used in conjunction with HU. We outline our current therapeutic strategy for EPO use in SCD.

 

answered Jun 30, 2012 by Jan B. Wade (4,930 points)

Here is something on Hydroxyurea

 

Hydroxyurea

Severe sickle cell anemia can be treated with a medicine called hydroxyurea. This medicine prompts your body to make fetal hemoglobin. Fetal hemoglobin, or hemoglobin F, is the type of hemoglobin that newborns have.
 

In people who have sickle cell anemia, fetal hemoglobin helps prevent red blood cells from sickling and improves anemia.
 

Given daily, hydroxyurea reduces how often painful sickle cell crises and acute chest syndrome occur. Many people taking hydroxyurea also need fewer blood transfusions and have fewer hospital visits.
 

Doctors are studying the long-term effects of hydroxyurea on people who have sickle cell anemia. Early studies in children suggest that the medicine may help improve growth and preserve organ function, but this has not been proven.
 

Hydroxyurea can reduce the number of white blood cells in your blood. (These cells help fight infections.) This can lead to an increased risk of infections.
 

People who take hydroxyurea must have careful medical followup, including blood tests. The dose of this medicine may need to be adjusted to reduce the risk of side effects.
 

A doctor who has knowledge about hydroxyurea can tell you about the risks and benefits of taking this medicine.

 

Hydroxyurea has also been approved for pediatric patients.

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