Blood rheology and 2,3-diphosphoglycerate levels after erythropoietin treatment

Twenty-seven transfusion dependent patients with end-stage renal dis­ ease on long-term dialysis had blood cell counts, serum chemistries, blood pressure, and whole blood viscosity measured, as well as having transfu­ sion requirem ents assessed. Three months after the institution of recombi­ nant hum an erythropoietin (rHU-EPO) (75 u per kg per wk), there was an 88 percent fall in transfusion requirem ent. After four months, the hemato­ crit increased from 24 ± 3.8 to 25.6 ± 4.2 percent, mean corpuscular volume from 93 ± 4.9 to 97 ± 6.6 fl, 2-3-diphosphoglycerate (2,3-DPG) from 13.2 ± 3.2 to 15.6 ± 4.3 |xM per g of Hb. Whole blood viscosity fell from 14.1 ± 2 .1 to 12.7 ± 2.3 seconds, and ferritin levels fell from 3282 ± 3889 to 2131 ± 2441 ng per ml. In eight patients in whom the dose of rHU-EPO was further increased by up to 50 units per kg three times weekly for three months, the hematocrit rose further to 29.3 ± 3.0 percent and the rise in hematocrit was accompanied by a further increase in 2,3-DPG to 17.9 ± 2.8 (xM per g of Hb (p < 0.03). There were no major side effects or vascular complications. * This work was supported in part by the U.S. Navy (ONR Contract N00014-88-C0118), with the funds provided by the Naval Medical Research and Development Command, and a Transfusion Medicine Aca­ demic Award from the National Heart, Lung and Blood Institute (K07 HLO125901A1). The opinions or assertions contained herein are those of the authors and are not to be construed as official or reflecting the views of the Navy Department or the Naval Service at large. t Reprint requests can be sent to: James P. Crowley, M.D., Division of Clinical Hematology, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903.