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Epogen and blood transfusions
Apr 20, 2004

Hi!! I just was wondering how Epogen works and how you can use it to decrease the number of blood transfusions that may be required? Thanks so much for your time!, curious girl

Response from Dr. Frascino

Hi Curious Girl,

You were wondering how Procrit (epogen) works? Well, the easy answer to that is: "It works very well!" but, that's probably not the primary intent of your question, is it?

OK, here's the scoop. Erythropoietin is a hormone produced by our kidneys. This hormone helps stimulate bone marrow production of red blood cells, thus increasing hemoglobin levels and alleviating symptoms, such as fatigue, that are associated with anemia. Procrit (epogen) is a manufactured version of our naturally occurring erythropoietin. It is manufactured by recombinant DNA technology, and has the exact same biological effects as the naturally occurring hormone, erythropoietin. That means Procrit, exactly like our naturally-occurring erythropoietin, stimulates the production of new red blood cells in our bone marrow.

Next, the transfusion part of your question. Transfusions can be life saving when treating severe anemia. However, there are a variety of well known risk and shortcomings associated with blood transfusions, including:

1. Transmission of bloodborne infections 2. Hemolytic reactions 3. Volume overload 4. Inconvenience 5. Supply deficits for certain blood types 6. Allergic-type reactions 7. Iron overload

These and other reasons make transfusion a less than ideal method for treating mild to moderate anemia. There are also special risks of blood transfusion for HIV-infected patients, including:

1. Immunosuppression 2. Transient increases in HIV viral load 3. CMV infection 4. Increased risk of death

Consequently, we try to minimize or eliminate the need for blood transfusions whenever possible. That's where Procrit comes in. As I mentioned above, Procrit stimulates the production of new red blood cells. It has been extensively studied in HIV-positive patients for the treatment of HIV-related anemia and found to be highly effective and remarkably safe. These studies clearly demonstrate Procrit's ability to increase hemoglobin levels, improve functional status, enhance quality of life, and decrease the requirement for blood transfusions! There is even an association with improved survival.

Several years ago, I was part of a four-month clinical trial assessing the effects of Procrit on the quality of life of HIV-positive patients. We found transfusion requirements significantly decreased form 20% to 5% over the four-month period of the study. (Abrams, Steinhart, Frascino. Epoetin alfa therapy for anemia in HIV-infected patients: impact on quality of life. International Journal of STD's and AIDS. 2000; 11:659-665.)

So Curious Girl, back to my original point. How does Procrit work? It works very well. Second, can Procrit decrease the need for blood transfusions for HIV-related anemia? Yes, and I've cited one of my published clinical research papers to support that fact.

Now you don't have to be "curious" any longer.

Dr. Bob


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