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Procrit and blood transfusions
Nov 7, 2002

Dr. Frascino, Help! I've been HIV positive for many years and finally my viral loasd is coming down but I'm anemic. I've been getting blood transfusions which help for a while. I don't want to change my HIV meds as I don't have many (or any) options left. I want to try Procrit but my doctor say's if I start it I'll have to stop the blood transfusions and that scares me. How come these two things can't be used together? Is there some risk? What should I do? I'm confused and don't want to make a decision I'll be sorry for later. I really trust your opinion. Thanks for everything that you do for all of us. It helps knowing you are on our side!!! You are our lifeline! Cody

Response from Dr. Frascino

Hey Cody,

I see 2 possibilities here:

1. you misunderstood what your doctor was saying or 2. Your doctor doesn't know what the hell he's talking about.

Let's hope it's number 1. There is absolutely no reason why Procrit can not be used with blood transfusions. In fact, one of the main indications for using Procrit is to decrease the frequency, quantity, and, in fact, necessity of blood transfusions.

Let me give you and our readers a bit of background. The treatment of anemia in HIV-positive patients should be directed at correcting the underlying cause of the anemia whenever possible. For example, in patients who are deficient in vitamin B12, iron, or folate, we treat them by supplementing them with the nutrient they are lacking. Another treatment option involves changing your HIV drug regimen to avoid medications that suppress red blood cell production. AZT is a prime example of a drug known to suppress red cell production. There are a variety of other drugs used to treat HIV or its complications that also could be contributing to the anemia. Sometimes dose modification may help; however, as in your case, there may not be an option to switch or dose modify. Treatment of anemia in HIV-positive folks should be considered whenever the hemoglobin levels fall below the normal values (14-18 g/dL for men and 12-16 g/dL for women). The goals of treating anemia are to correct the deficient red blood cell production, maintain or improve quality of life - including functional status - and to prolong survival. The 2 primary anemia treatment options, for folks who don't have nutritional deficiencies or other easily correctable causes of anemia, are blood transfusion and Procrit (erythropoietin).

Blood transfusions carry significant risks, including transmission of other viral infections, allergic reactions, and immunosuppression, all things we HIV+ folks certainly want to avoid, if at all possible. Second, blood transfusions are inconvenient and the beneficial effects are transient. Certainly blood transfusions have their roll in treatment of anemia, even in HIV+ folks, but the general rule is that they should be minimized whenever possible. We now resort to blood transfusions only for patients who have rapid declines in hemoglobin (for instance, secondary to active bleeding or surgery), extremely low hemoglobin levels (in which case, transfusions can be life-saving), or in folks who exhibit very pronounced anemia-related symptoms. Transfusions are rarely, if ever, warranted for patients with chronic stable anemia, or for patients with minimal symptoms.

Procrit (erythropoietin) is biologically indistinguishable from erythropoietin, a hormone produced by the kidneys that stimulates and regulates red blood cell production in our bodies. Procrit is recommended as the treatment of choice for HIV-related anemia, including in those patients who require repeated blood transfusions. The clinical benefits of Procrit, which have been very well documented over the past decade in many clinical trials, include decreasing the frequency, quantity, and necessity of blood transfusions, improving quality of life, and prolonging survival. Procrit is safe and very well tolerated with no drug interactions. It is self-administered in a convenient once-per-week small injection given just under the skin.

It sounds to me that you are an ideal candidate for Procrit therapy. Call your doctor and discuss your concerns. Bring along a copy of this posting; it may help.

If your doctor continues to say it's one or the other, then it's back to option 2 - your doctor doesn't know what he's talking about. If that's the case, I would recommend getting out from under his care as quickly as possible. (Do not pass go; do not collect $200, etc.)

Yes, I'm definitely on your side. Let's all get through this together, OK? Good luck.

Dr. Bob


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