SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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J Obuljen1 , V Zizic1 , M Nakic2 , J Stepan3 , G Jakovljevic3 , D Curic1 , I Linaric1 , J Lenicek-Krleza1 , I Tadic1

1Biochemical Laboratory, Children's Hospital Zagreb, 2Hematological Laboratory, Children's Hospital Zagreb, 3Oncology Department,, Children's Hospital Zagreb

Erythropoietin (Epo) is a glycoprotein hormone produced primarly by the kidneys in response to hypoxia, secreted into the plasma. Defective erythropoesis and not inadeqeate Epo activity is thougt to be responsibile for cancer-related anaemia. In children suffering from solid malignancies anaemia causes constitutional symptoms affecting the quality of life, may delay chemotherapy or lead to blood transfusion. Treatment with recombinant human erythropoietin (rHuEpo) is effective in patients when hemoglobin conc. is below 100 g/l, but uncertain for conc. between 100 and 120 g/L.
The aim was to determine baseline Epo level in children with solid tumors and compare it with values of red blood cell (RBC), hematocrite (Hct), hemoglobin (Hgb), mean corpuscular hemoglobin (MCH), iron conc. (Fe), total iron binding capacity (TIBC) and ferritin. Serum Epo levels were measured by enzyme immunoassay in group of 19 patients, receiving no chemotherapy and in control group of 11 healthy children. Values from the control group are: mean Epo conc. 9,2 mU/ml; RBC 4,70x10^12/L; Hgb 128,8 g/L; Hct 0,37; MCH 27,5; ferritin 37,43 ng/ml; Fe 18,49 umol/L; TIBC 69,26 umol/L. Epo concentration showed no correlation with any parameter. Patients from the group with solid tumors had cancer-related chronic anaemia, mean Epo 99,88 mU/ml; RBC 3,52x10^12/L; Hgb 97,8 g/L; Hct 0,30; MCH 26,89; ferritin 555,4 ng/ml; Fe 8,91 umol/L; TIBC 50,49 umol/L. Spearman's test showed negative correlation between hemoglobin and Epo level (r=- 0.560, p < 0,05).
Children with solid tumors had the ability to react on hypoxia by increasing the Epo level, but it was not enough to improve anaemia. Latest data suggest that erytropoietin is effective and safe in the prophylaxis and treatment of cancer-related anaemia, so there is an indication for introducing rHuEpo in our patients. Further studies are needed to evaluate the dose regimen and potential value of baseline Epo concentation in predicting the answer to therapy.


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