REDUCED SERUM LEVELS OF IMMUNOREACTIVE ERYTHROPOIETIN IN PATIENTS WITH CIRRHOSIS AND CHRONIC ANEMIA

Chronic anemia is frequently observed in patients affected by cirrhosi s. To investigate the possible role of erythropoietin (Epo) in the pat hogenesis of anemia in cirrhosis, we measured the immunoreactive Epo l evels and the respective hemoglobin (Hb) concentrations in 48 anemic a nd nonanemic cirrhotic patients and in a control group of healthy subj ects and patients with iron-deficiency anemia. Epo concentrations were determined in serum using a sensitive enzyme immunoassay. The regress ion curve between Epo values and Hb concentrations showed a significan t inverse exponential trend both in cirrhotic patients (r = -.55; P < .0001) and controls (r = -.92; P < .0001), in a semilogarithmic plot, the line slope obtained in cirrhotic patients was significantly lower (P < .005) than that of controls, suggesting a blunt Epo response to a nemia in cirrhosis. Moreover, covariance analysis showed that the Epo levels for a given degree of anemia were furtherly reduced in the pati ents with a more severe disease, suggesting a close relation between c irrhosis and the mechanisms involved in the derangement of the Epo fee dback system. Finally, the Epo concentrations measured in the cirrhoti c patients without anemia did not significantly differ from Epo values obtained in healthy subjects. An impaired Epo response may play a rol e in maintaining low Hb concentrations in cirrhotic patients with anem ia. However, the evidence of a residual Epo response to anemia in cirr hosis and the presence of normal basal Epo levels in nonanemic cirrhot ic patients do not support an inadequate Epo secretion as one of the p rimary causes of anemia in cirrhosis.