Goodnough L T, Skikne B, Brugnara C
Departments of Medicine and Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA.
Blood. 2000 Aug 1;96(3):823-33.
Recent knowledge gained regarding the relationship between erythropoietin, iron, and erythropoiesis in patients with blood loss anemia, with or without recombinant human erythropoietin therapy, has implications for patient management. Under conditions of significant blood loss, erythropoietin therapy, or both, iron-restricted erythropoiesis is evident, even in the presence of storage iron and iron oral supplementation. Intravenous iron therapy in renal dialysis patients undergoing erythropoietin therapy can produce hematologic responses with serum ferritin levels up to 400 microg/L, indicating that traditional biochemical markers of storage iron in patients with anemia caused by chronic disease are unhelpful in the assessment of iron status. Newer measurements of erythrocyte and reticulocyte indices using automated counters show promise in the evaluation of iron-restricted erythropoiesis. Assays for serum erythropoietin and the transferrin receptor are valuable tools for clinical research, but their roles in routine clinical practice remain undefined. The availability of safer intravenous iron preparations allows for carefully controlled studies of their value in patients undergoing erythropoietin therapy or experiencing blood loss, or both.
近期关于失血贫血患者（无论是否接受重组人促红细胞生成素治疗）促红细胞生成素、铁与红细胞生成之间关系的研究成果，对患者管理具有重要意义。在大量失血、促红细胞生成素治疗或二者并存的情况下，即便存在储存铁且口服补充铁剂，铁限制型红细胞生成依然明显。接受促红细胞生成素治疗的肾透析患者静脉补铁治疗可使血清铁蛋白水平高达400μg/L时产生血液学反应，这表明慢性病所致贫血患者传统的储存铁生化标志物无助于评估铁状态。使用自动计数仪对红细胞和网织红细胞指数进行的更新测量，在评估铁限制型红细胞生成方面显示出前景。血清促红细胞生成素和转铁蛋白受体检测是临床研究的宝贵工具，但其在常规临床实践中的作用仍不明确。更安全的静脉铁制剂的出现，使得能够对其在接受促红细胞生成素治疗或失血或二者并存的患者中的价值进行严格对照研究。
