Open Access Review

Erythropoietin in the intensive care unit: beyond treatment of anemia

Nimesh SA Patel1*, Massimo Collino2, Muhammad M Yaqoob1 and Christoph Thiemermann1

Author Affiliations

1 Centre for Translational Medicine & Therapeutics, Queen Mary University of London, William Harvey Research Institute, Barts and The London, London, UK

2 Department of Anatomy, Pharmacology and Forensic Medicine, University of Turin, Turin, Italy

For all author emails, please log on.

Annals of Intensive Care 2011, 1:40  doi:10.1186/2110-5820-1-40

Published: 23 September 2011

Abstract

Erythropoietin (EPO) is the major hormone stimulating the production and differentiation of red blood cells. EPO is used widely for treating anemia of critical illness or anemia induced by chemotherapy. EPO at pharmacological doses is used in this setting to raise hemoglobin levels (by preventing the apoptosis of erythroid progenitor cells) and is designed to reduce patient exposure to allogenic blood through transfusions. Stroke, heart failure, and acute kidney injury are a frequently encountered clinical problem. Unfortunately, in the intensive care unit advances in supportive interventions have done little to reduce the high mortality associated with these conditions. Tissue protection with EPO at high, nonpharmacological doses after injury has been found in the brain, heart, and kidney of several animal models. It is now well known that EPO has anti-apoptotic effects in cells other than erythroid progenitor cells, which is considered to be independent of EPOs erythropoietic activities. This review article summarizes what is known in preclinical models of critical illness and discusses why this does not correlate with randomized, controlled clinical trials.