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Fatigue and AnemiaFatigue and Anemia
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Feb 8, 2003

I'm confused. Is erythropoetin the same thing as Procrit? And is Procrit made in the bone marrow. Does it help all kinds of anemia or just the HIV type? Since my hemaglobin is low am I automatically considered anemic even if I don't feel really all that bad yet? Will I feel worse? Should anemia be treated even if it's not too bad yet or should I wait? Thanks Dr. Bob, Only a bit tired so far.

Response from Dr. Frascino

Hello "Only a bit tired so far,"

Yes, I can see how this can all be a bit confusing, but you've come to the right place for answers!

1. Is erythropoietin the same thing as Procrit? This is a bit confusing, because Procrit is "identical" to erythropoietin, but not exactly the same thing. Erythropoietin is a hormone produced in the kidneys that stimulates the bone marrow to produce new red blood cells. Procrit is a medication produced in the laboratory to be "identical" to the naturally occurring erythropoietin. It is administered by a small injection given just under the skin. 2. Is Procrit made in the bone marrow? Nope, Procrit is made in the laboratory. Naturally occurring erythropoietin is manufactured in the kidneys. Both naturally occurring erythropoietin and Procrit work in the bone marrow to stimulate the production of new red blood cells. 3. Does Procrit help all kinds of anemia? No. Anemia can be caused by lots of different conditions, from blood loss to nutritional deficiencies to medication toxicities to HIV itself. The treatment of anemia depends on the cause. If, for example, your anemia were caused by dietary insufficiencies of iron, vitamin B12 or folic acid, then the appropriate treatment would be nutritional supplements. Procrit, however, would definitely be the treatment of choice for anemia of chronic disease (cancer, kidney disease, or HIV) or anemia resulting from AZT suppression of the bone marrow. 4. Are you anemic if your hemoglobin is low, even if you don't feel really bad yet? Anemia is most frequently defined by using the hemoglobin level. Hemoglobin is an iron-containing protein that helps red blood cells carry oxygen throughout the body. The normal values for hemoglobin are 12-16 g/dL for women and 14-18 g/dL for men. By definition, you are anemic when your hemoglobin or red blood cell count falls below the normal range. Symptoms of anemia tend to get worse as the hemoglobin level falls. Symptoms may include extreme tiredness, shortness of breath, rapid heartbeat, paleness, headaches, decreased sex drive, fatigue, weakness, and inability to concentrate. That you don't feel bad "yet" may be due to the fact that your hemoglobin is only slightly below the normal range. Also, anemia that comes on gradually may not be all that noticeable, because we tend to compensate for the lack of energy.

5) Will you feel worse? If the anemia worsens (hemoglobin goes down), so will your symptoms

6) Should anemia be treated or should you wait? Significant anemia should always be treated. In the setting of HIV disease (and cancer), studies have shown that treatment of even mild to moderate anemia is associated with enhanced quality of life, increased energy level, and improved survival. Should you be treated? Check your hemoglobin level and discuss the potential causes and treatment options with your HIV/AIDS specialist. I tend to opt for early treatment. Why be even "a bit tired" if there is an easy solution to improved vitality as well as an association with improved survival!

Hope that helps clarify things. Write back if you are still confused or need additional information.

Stay well. Stay energized!

Dr. Bob

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