Erythropoietin deficiency and anaemia in multiple system atrophy

Serum erythropoietin (EPO) levels are partially controlled by the sympathet ic outflow to the kidney. We have studied whether patients with multiple sy stem atrophy (MSA), known to be associated with dysautonomia. are EPO-defic ient. Eighteen MSA patients were studied along with 32 idiopathic Parkinson 's disease (PD) patients, 23 controls with iron-deficiency anaemia, and 18 healthy individuals. Serum creatinine was normal in all groups. Mean haemog lobin (Hb) concentration in MSA patients was 13.7 +/- 1.7 g/dL. Four MSA pa tients had unexplained anaemia (minimum Hb: 10.5 g/dL) and abnormal autonom ic function tests including significant postural hypotension, whereas none of the PD patients was anaemic. Serum EPO levels were suppressed in relatio n to anaemia in MSA patients compared to elevated EPO levels in iron-defici ency anaemia patients (difference of regression lines P < 0.001), indicatin g EPO deficiency in the anaemic MSA patients. Serum EPO levels in PD patien ts were within normal range. A subset of MSA patients has anaemia and postu ral hypotension. which may be associated with EPO deficiency. This may have therapeutic implications. <(c)> 2001 Movement Disorder Society.