SERUM ERYTHROPOIETIN CONCENTRATION IN ANEMIA OF VISCERAL LEISHMANIASIS (KALA-AZAR) BEFORE AND DURING ANTIMONIAL THERAPY

Serum erythropoietin (Epo) concentrations and variables of red cell an d iron status were studied in 27 Sudanese patients who were treated wi th sodium stibogluconate for visceral leishmaniasis (kala-azar). Blood haemoglobin increased from 6.4 (+/-1.7 SD) to 9.5 (+/-1.4)g/dl during treatment. Serum ferritin decreased concomitantly. Serum iron levels were unchanged whereas the total iron binding capacity increased sligh tly. The pre-treatment serum Epo concentration in relation to the bloo d haemoglobin concentration was not as high as expected from the one i n primary haematological diseases, indicating that there is a relative lack of Epo in anaemic kala-azar patients. Serum Epo further decrease d during stibogluconate therapy. The normal dependence of the serum Ep o level on the blood haemoglobin concentration was lost during mid-ter m antimonial treatment, but it recovered thereafter. Cell culture stud ies with the human hepatoma cells HepG2 showed that stibogluconate (gr eater than or equal to 30 mu g/ml inhibited Epo gene expression. Thus, effective treatment of kala-azar with stibogluconate results in impro vement of anaemia, although the drug itself may impair Epo production.