Department of Pathology and Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Transfusion. 2012 Jul;52(7):1584-92. doi: 10.1111/j.1537-2995.2011.03495.x. Epub 2011 Dec 29.
The relationships between erythropoietin (EPO), iron, and erythropoiesis and the presence of iron-restricted erythropoiesis have important implications in anemia management. Iron-restricted erythropoiesis occurs in the presence of one or more iron deficiency syndromes: absolute iron deficiency, functional iron deficiency, and/or iron sequestration. Absolute iron deficiency is a common nutritional deficiency in women's health, pediatrics, and the elderly and is therefore an important public health problem. Functional iron deficiency occurs in patients with significant EPO-mediated erythropoiesis or therapy with erythropoiesis-stimulating agents, even when storage iron is present. Iron sequestration mediated by hepcidin is an underappreciated but common cause of iron-restricted erythropoiesis in patients with chronic inflammatory disease. The challenge for treating and laboratory-based physicians is to understand the contributory role(s) of each of these syndromes, so that the potential value of emerging and innovative pharmacologic strategies can be considered as options in patient blood management.
促红细胞生成素 (EPO)、铁和红细胞生成之间的关系以及铁限制红细胞生成的存在对贫血管理具有重要意义。铁限制红细胞生成发生在存在一种或多种缺铁综合征的情况下：绝对缺铁、功能性缺铁和/或铁螯合。绝对缺铁是妇女健康、儿科和老年人的常见营养缺乏症，因此是一个重要的公共卫生问题。功能性缺铁发生在存在大量 EPO 介导的红细胞生成或使用红细胞生成刺激剂的患者中，即使铁储存存在。铁蛋白介导的铁螯合是慢性炎症性疾病患者铁限制红细胞生成的一个被低估但常见的原因。治疗和基于实验室的医生面临的挑战是了解这些综合征中的每一种的促成作用，以便可以考虑新兴和创新的药物治疗策略作为患者血液管理的选择。
