Thursday September 28, 2006
Erythropoetin and replacement of Iron

Although use of erythropoetin (and its long acting cousin - darbepoetin) are usually not part of acute treatments in ICU but are in considerable use for long term, kidney failure, Jehovah's Witnesses and other patients. We all are aware that erythropoetin will not work if patient is deficient in iron storage. But there are 3 points to remember.

1. Simply checking Fe level may not provide reliable answer to Fe storage 1.
2. Erythropoetin, by stimulating erythropoiesis to greater than physiologic level, may induce iatrogenic functional iron deficiency.
3. Oral iron may take longer and may not satisfy the requirement and extra dose of IV iron may be needed.

The simple formula to see if a supplemental iron is required:

Transferrin saturation less than 25%
Or/And
Ferritin less than 100 g/dl

Related previous pearls:

Intravenous(IV) Iron with dose calculations
ICU anemia score
Phlebotomy and anemia in ICU

Reference: Click to get absract
Diagnosis and management of iron-related anemias in critical illness. Critical Care Medicine. 34(7):1898-1905, July 2006