el-Reshaid K, Johny K V, Hakim A, Kamel H, Sebeta A, Hourani H, Kanyike F B
Department of Medicine, Faculty of Medicine, Kuwait University, Safat.
Acta Haematol. 1994;91(3):130-5. doi: 10.1159/000204318.
Erythropoietic response to exogenously administered recombinant human erythropoietin (rHuEpo) was examined in 11 maintenance haemodialysis patients with iron overload (IO). All had required numerous blood transfusions earlier (> 12 units/year). Diagnosis of IO was established by high serum ferritin (SF) levels (> 1,100 micrograms/l), high hepatic CT density (> 70 Hounsfield units; HU) and excessive iron stores in bone marrow aspirate (grade 6). None of the patients had osteitis fibrosa cystica, aluminium intoxication, haemoglobinopathy or haemochromatosis alleles (HLA A3, B7 and B14). All patients responded to rHuEpo treatment (target haemoglobin level of 9-10 g/dl). None of the patients required iron supplementation or developed 'functional anaemia'. During 30 +/- 3 months of therapy, the initial maintenance dose of rHuEpo (103 +/- 12 units/kg/week) and median SF levels (2,250 micrograms/l) fell (50 +/- 8 units/kg/week and 1,060 micrograms/l, respectively) (p = 0.0003 and 0.0007). The initial and final rHuEpo doses correlated well with the respective SF levels (r = 0.89, p < 0.001). The maintenance dose of rHuEpo required for patients with IO at the start of the treatment period was significantly higher than that (50 +/- 5 units/kg/week) required by a control group of patients with adequate iron stores (SF = 100-600 micrograms/l) who were matched for age, sex and frequency of previous blood transfusions (p = 0.002). The findings suggested that excessive IO caused relative resistance to erythropoiesis on exogenous administration of rHuEpo and that iron supplementation was not warranted during rHuEpo therapy in those patients.
对11例维持性血液透析且伴有铁过载（IO）的患者，研究了其对外源性给予重组人促红细胞生成素（rHuEpo）的红细胞生成反应。所有患者此前均需要大量输血（>12单位/年）。通过高血清铁蛋白（SF）水平（>1100微克/升）、高肝脏CT密度（>70亨氏单位；HU）以及骨髓穿刺中铁储存过多（6级）来确诊IO。患者均无纤维囊性骨炎、铝中毒、血红蛋白病或血色素沉着病等位基因（HLA A3、B7和B14）。所有患者对rHuEpo治疗均有反应（目标血红蛋白水平为9 - 10克/分升）。患者均无需补充铁剂或出现“功能性贫血”。在30±3个月的治疗期间，rHuEpo的初始维持剂量（103±12单位/千克/周）和SF中位数水平（2250微克/升）均下降（分别降至50±8单位/千克/周和1060微克/升）（p = 0.0003和0.0007）。rHuEpo的初始剂量和最终剂量与各自的SF水平相关性良好（r = 0.89，p < 0.001）。治疗初期IO患者所需的rHuEpo维持剂量显著高于年龄、性别和既往输血频率相匹配的铁储存充足（SF = 100 - 600微克/升）的对照组患者所需剂量（50±5单位/千克/周）（p = 0.002）。这些发现表明，过量的IO对外源性给予rHuEpo时的红细胞生成产生相对抵抗，并且在这些患者的rHuEpo治疗期间无需补充铁剂。
