Erythropoietin, the biology of erythropoiesis and epoetin alfa - An overview

Erythropoietin, a glycoprotein hormone, is synthesized predominantly in the kidney and secreted by renal cortical interstitial cells in response to ti ssue hypoxia. Erythropoietin is the main regulator of the production of red blood cells. It functions in the recruitment and differentiation of erythr oid progenitor cells and aids in their maintenance and survival. Erythropoi etin also simulates the synthesis of hemoglobin. In the last 15 years, the ready availability of recombinant human erythropoietin (r-HuEPO, epoetin al fa) has permitted the clinical investigation and application of this hormon e to the treatment of anemia in various patient populations. Epoetin alfa h as been shown to accelerate erythropoiesis and reduce allogeneic blood tran sfusion in major elective, noncardiac, nonvascular surgery and in certain a nemic patients with chronic renal failure, nonmyeloid malignancies and huma n immunodeficiency virus infection. In addition to improving hematologic pa rameters, epoetin alfa therapy can enhance health-related quality of life i n these patients. The success of epoetin alfa in treating anemia in other s urgical populations suggests that it may be of benefit in treating the peri operative anemia that is highly prevalent in gynecologic surgery patients. Further investigation of the use of epoetin alfa in patients undergoing gyn ecologic surgery would increase awareness of its benefits for this patient population.