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Montero D, Haider T, Barthelmes J, Goetze JP, Cantatore S, Lundby C, Sudano I, Ruschitzka F, Flammer AJ. Age-dependent impairment of the erythropoietin response to reduced central venous pressure in HFpEF patients. Physiol Rep 2019; 7:e14021. [PMID: 30821129 PMCID: PMC6395308 DOI: 10.14814/phy2.14021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 12/22/2022] Open
Abstract
Despite growing research interest in the pathophysiology of heart failure with preserved ejection fraction (HFpEF), it remains unknown whether central hemodynamic alterations inherently present in this condition do affect blood pressure and blood volume (BV) regulation. The present study sought to determine hemodynamic and endocrine responses to prolonged orthostatic stress in HFpEF patients. Central venous pressure (CVP) assessed via the internal jugular vein (IJV) aspect ratio with ultrasonography, arterial pressure and heart rate were determined at supine rest and during 2 hours of moderate (25-30°) head-up tilt (HUT) in 18 stable HFpEF patients (71.2 ± 7.3 years), 14 elderly (EC), and 10 young (YC) healthy controls. Parallel endocrine measurements comprised main BV-regulating hormones: pro-atrial natriuretic peptide, copeptin, aldosterone, and erythropoietin (EPO). At supine rest, the IJV aspect ratio was higher (>30%) in HFpEF patients compared with EC and YC, while mean arterial pressure was elevated in HFpEF patients (98.0 ± 13.1 mm Hg) and EC (95.6 ± 8.3 mm Hg) versus YC (87.3 ± 5.0 mm Hg) (P < 0.05). HUT increased heart rate (+10%) and reduced the IJV aspect ratio (-52%), with similar hemodynamic effects in all groups (P for interaction ≥ 0.322). The analysis of endocrine responses to HUT revealed a group×time interaction for circulating EPO, which was increased in YC (+10%) but remained unaltered in HFpEF patients and EC. The EPO response to a given reduction in CVP is similarly impaired in HFpEF patients and elderly controls, suggesting an age-dependent dissociation of EPO production from hemodynamic regulation in the HFpEF condition.
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Affiliation(s)
- David Montero
- University Heart CenterUniversity Hospital ZurichZurichSwitzerland
- Libin Cardiovascular Institute of Alberta, Faculty of KinesiologyUniversity of CalgaryCalgaryCanada
| | - Thomas Haider
- Institute of PhysiologyUniversity of ZurichZurichSwitzerland
| | - Jens Barthelmes
- University Heart CenterUniversity Hospital ZurichZurichSwitzerland
| | - Jens P. Goetze
- Department of Clinical BiochemistryRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | | | - Carsten Lundby
- Department of Clinical MedicineRigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Isabella Sudano
- University Heart CenterUniversity Hospital ZurichZurichSwitzerland
| | - Frank Ruschitzka
- University Heart CenterUniversity Hospital ZurichZurichSwitzerland
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Montero D, Lundby C. Regulation of Red Blood Cell Volume with Exercise Training. Compr Physiol 2018; 9:149-164. [DOI: 10.1002/cphy.c180004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Montero D, Diaz-Cañestro C, Flammer A, Lundby C. Unexplained Anemia in the Elderly: Potential Role of Arterial Stiffness. Front Physiol 2016; 7:485. [PMID: 27826252 PMCID: PMC5078728 DOI: 10.3389/fphys.2016.00485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- David Montero
- Department of Cardiology, University Heart Center, University Hospital Zurich Zurich, Switzerland
| | | | - Andreas Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich Zurich, Switzerland
| | - Carsten Lundby
- Zurich Center for Integrative Human Physiology, Institute of Physiology, University of Zurich Zurich, Switzerland
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Vigué B, Leblanc PE, Moati F, Pussard E, Foufa H, Rodrigues A, Figueiredo S, Harrois A, Mazoit JX, Rafi H, Duranteau J. Mid-regional pro-adrenomedullin (MR-proADM), a marker of positive fluid balance in critically ill patients: results of the ENVOL study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:363. [PMID: 27825364 PMCID: PMC5101658 DOI: 10.1186/s13054-016-1540-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/20/2016] [Indexed: 12/14/2022]
Abstract
Background The optimal control of blood volume without fluid overload is a main challenge in the daily care of intensive care unit (ICU) patients. Accordingly this study focused on the identification of biomarkers to help characterize fluid overload status. Methods Sixty-seven patients were studied from ICU admission to day 7 (D7). Blood and urine samples were taken daily and sodium and water balance strictly calculated resulting in a total cumulative assessment of ∆Na+ and ∆H2O. Furthermore, plasmatic biomarkers (cortisol, epinephrine, norepinephrine, renin, angiotensin II, aldosterone, pro-endothelin, copeptine, atrial natriuretic peptide, erythropoietin, mid-regional pro-adrenomedullin (MR-proADM)) and Sequential Organ Failure Assessment (SOFA) scores were measured at D2, D5 and D7. Blood volumes were measured with 51Cr fixed on red blood cells at D2 and D7. Results The ∆Na+ or ∆H2O were increased in all patients but never related to blood volumes at D2 nor D7. Total blood volumes were at normal values with constantly low red blood cell volumes and normal or decreased plasmatic volume. Weight, plasmatic proteins, and hemoglobin were weakly related to ∆Na+ or ∆H2O. Amongst all tested biomarkers, only MR-proADM was related to sodium and fluid overload. This biomarker was also a predictor of SOFA scores. Conclusions Plasmatic concentration in MR-proADM seems to be a good surrogate for evaluation of ∆Na+ or ∆H2O and predicts sodium and extracellular fluid overload. Trial registration ClinicalTrials.gov: NCT01858675 in May 13, 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13054-016-1540-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bernard Vigué
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France.
| | - Pierre-Etienne Leblanc
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Frédérique Moati
- Service de biophysique et de médecine nucléaire, Centre Hospitalier Universitaire de Bicêtre, Assistance publique - Hôpitaux de Paris, Paris, France
| | - Eric Pussard
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Inserm U1185, Centre Hospitalier Universitaire de Bicêtre, Assistance publique - Hôpitaux de Paris, Paris, France
| | - Hussam Foufa
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Aurore Rodrigues
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Samy Figueiredo
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Anatole Harrois
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Jean-Xavier Mazoit
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Homa Rafi
- Thermo Fisher Scientific, Asnières sur Seine, France
| | - Jacques Duranteau
- Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
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Montero D, Rauber S, Goetze JP, Lundby C. Reduction in central venous pressure enhances erythropoietin synthesis: role of volume-regulating hormones. Acta Physiol (Oxf) 2016; 218:89-97. [PMID: 27169519 DOI: 10.1111/apha.12708] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/11/2016] [Accepted: 05/09/2016] [Indexed: 02/04/2023]
Abstract
AIMS Erythropoiesis is a tightly controlled biological event, but its regulation under non-hypoxic conditions, however, remains unresolved. We examined whether acute changes in central venous blood pressure (CVP) elicited by whole-body tilting affect erythropoietin (EPO) concentration according to volume-regulating hormones. METHODS Plasma EPO, angiotensin II (ANGII), aldosterone, pro-atrial natriuretic peptide (proANP) and copeptin concentrations were measured at supine rest and up to 3 h during 30° head-up (HUT) and head-down tilt (HDT) in ten healthy male volunteers. Plasma albumin concentration was used to correct for changes in plasma volume and CVP was estimated through the internal jugular vein (IJV) aspect ratio with ultrasonography. RESULTS From supine rest, the IJV aspect ratio was decreased and increased throughout HUT and HDT respectively. Plasma EPO concentration increased during HUT (13%; P = 0.001, P for linear component = 0.017), independent of changes in albumin concentration. Moreover, ANGII and copeptin concentrations increased during HUT, while proANP decreased. The increase in EPO concentration during HUT disappeared when adjusted for changes in copeptin. During HDT, EPO, ANGII and copeptin concentrations remained unaffected while proANP increased. In regression analyses, EPO was positively associated with copeptin (β = 0.55; 95% CI = 0.18, 0.93; P = 0.004) irrespective of changes in other hormones and albumin concentration. CONCLUSION Reduction in CVP prompts an increase in plasma EPO concentration independent of hemoconcentration and hence suggests CVP per se as an acute regulator of EPO synthesis. This effect may be explained by changes in volume-regulating hormones.
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Affiliation(s)
- D. Montero
- Institute of Physiology; Zurich Center for Integrative Human Physiology (ZIHP); University of Zurich; Zurich Switzerland
| | - S. Rauber
- Institute of Physiology; Zurich Center for Integrative Human Physiology (ZIHP); University of Zurich; Zurich Switzerland
| | - J. P. Goetze
- Department of Clinical Biochemistry; Copenhagen and Aarhus University; Aarhus Denmark
| | - C. Lundby
- Institute of Physiology; Zurich Center for Integrative Human Physiology (ZIHP); University of Zurich; Zurich Switzerland
- Institute of Physiology; National Center of Competence in Research Kidney. CH; University of Zurich; Switzerland
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Montero D, Diaz-Cañestro C, Keiser S, Lundby C. Arterial stiffness is strongly and negatively associated with the total volume of red blood cells. Int J Cardiol 2016; 221:77-80. [PMID: 27400301 DOI: 10.1016/j.ijcard.2016.06.265] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/24/2016] [Accepted: 06/27/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Erythropoiesis is partly regulated through classic feedback pathways that govern blood volume (BV) as sensed by veno-atrial but also arterial stretch receptors. Hence, the total volume of red blood cells (RBCV) could be associated with arterial stiffness (AS), although such hypothesis has not yet been tested. Therefore, we sought to investigate the association of AS with hematological variables including RBCV. METHODS Fourteen healthy physically active individuals volunteered for the study (age=23±2). RBCV, plasma volume (PV), and BV were calculated from measures of hematocrit and total hemoglobin mass (Hbmass) determined by CO-rebreathing. Carotid compliance with ultrasonography and carotid-ankle pulse wave velocity (PWV) were determined at rest and immediately after a maximal exercise test. The rationale for assessment of AS after exercise derives from the potential marked role of AS in the regulation of erythropoiesis in the setting of reduced central venous pressure. RESULTS At rest, carotid compliance was positively associated with Hbmass, RBCV, BV, but not PV, with coefficients of determination (R(2)) ranging from 0.39 to 0.57. Following exercise, closer positive associations were observed between carotid compliance and Hbmass, RBCV, or BV. Moreover, carotid-ankle PWV was negatively associated with all hematological variables after exercise except for PV, with R(2) ranging from 0.49 to 0.75. Similar results were observed when adjusted by body weight. CONCLUSIONS AS is strongly and inversely associated with RBCV in healthy individuals. These findings suggest that AS may adversely intercede in the regulation of erythropoiesis through the alteration of mechanisms that control BV.
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Affiliation(s)
- David Montero
- Zurich Center for Integrative Human Physiology (ZIHP), Institute of Physiology, University of Zurich, Zurich, Switzerland.
| | | | - Stefanie Keiser
- Zurich Center for Integrative Human Physiology (ZIHP), Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Carsten Lundby
- Zurich Center for Integrative Human Physiology (ZIHP), Institute of Physiology, University of Zurich, Zurich, Switzerland
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Keramidas ME, Mekjavic IB, Kölegård R, Choukèr A, Strewe C, Eiken O. PlanHab: Hypoxia counteracts the erythropoietin suppression, but seems to exaggerate the plasma volume reduction induced by 3 weeks of bed rest. Physiol Rep 2016; 4:4/7/e12760. [PMID: 27081163 PMCID: PMC4831328 DOI: 10.14814/phy2.12760] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 03/16/2016] [Indexed: 11/24/2022] Open
Abstract
The study examined the distinct and synergistic effects of hypoxia and bed rest on the erythropoietin (EPO) concentration and relative changes in plasma volume (PV). Eleven healthy male lowlanders underwent three 21‐day confinement periods, in a counterbalanced order: (1) normoxic bed rest (NBR; PIO2: 133.1 ± 0.3 mmHg); (2) hypoxic bed rest (HBR; PIO2: 90.0 ± 0.4 mmHg, ambient simulated altitude of ~4000 m); and (3) hypoxic ambulation (HAMB; PIO2: 90.0 ± 0.4 mmHg). Blood samples were collected before, during (days 2, 5, 14, and 21) and 2 days after each confinement to determine EPO concentration. Qualitative differences in PV changes were also estimated by changes in hematocrit and hemoglobin concentration along with concomitant changes in plasma renin concentration. NBR caused an initial reduction in EPO by ~39% (P = 0.04). By contrast, HBR enhanced EPO (P = 0.001), but the increase was less than that induced by HAMB (P < 0.01). All three confinements caused a significant reduction in PV (P < 0.05), with a substantially greater drop in HBR than in the other conditions (P < 0.001). Thus, present results suggest that hypoxia prevents the EPO suppression, whereas it seems to exaggerate the PV reduction induced by bed rest.
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Affiliation(s)
- Michail E Keramidas
- Department of Environmental Physiology, Swedish Aerospace Physiology Center, School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Jozef Stefan Institute, Ljubljana, Slovenia
| | - Roger Kölegård
- Department of Environmental Physiology, Swedish Aerospace Physiology Center, School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
| | - Alexander Choukèr
- Department of Anaesthesiology, Stress and Immunology Lab, University of Munich, Munich, Germany
| | - Claudia Strewe
- Department of Anaesthesiology, Stress and Immunology Lab, University of Munich, Munich, Germany
| | - Ola Eiken
- Department of Environmental Physiology, Swedish Aerospace Physiology Center, School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden
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Annaheim S, Jacob M, Krafft A, Breymann C, Rehm M, Boutellier U. RhEPO improves time to exhaustion by non-hematopoietic factors in humans. Eur J Appl Physiol 2016; 116:623-33. [PMID: 26729211 DOI: 10.1007/s00421-015-3322-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/17/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Erythropoietin (EPO) controls red cell volume (RCV) and plasma volume (PV). Therefore, injecting recombinant human EPO (rhEPO) increases RCV and most likely reduces PV. RhEPO-induced endurance improvements are explained by an increase in blood oxygen (O2) transport capacity, which increases maximum O2 uptake ([Formula: see text]O2max). However, it is debatable whether increased RCV or [Formula: see text]O2max are the main reasons for the prolongation of the time to exhaustion (t lim) at submaximal intensity. We hypothesized that high rhEPO doses in particular contracts PV such that the improvement in t lim is not as strong as at lower doses while [Formula: see text]O2max increases in a dose-dependent manner. METHODS We investigated the effects of different doses of rhEPO given during 4 weeks [placebo (P), low (L), medium (M), and high (H) dosage] on RCV, PV, [Formula: see text]O2max and t lim in 40 subjects. RESULTS While RCV increased in a dose-dependent manner, PV decreased independent of the rhEPO dose. The improvements in t lim (P +21.4 ± 23.8%; L +16.7 ± 29.8%; M +44.8 ± 62.7%; H +69.7 ± 73.4%) depended on the applied doses (R (2) = 0.89) and clearly exceeded the dose-independent [Formula: see text]O2max increases (P -1.7 ± 3.2%; L +2.6 ± 6.8%; M +5.7 ± 5.1 %; H +5.6 ± 4.3 %) after 4 weeks of rhEPO administration. Furthermore, the absolute t lim was not related (R (2) ≈ 0) to RCV or to [Formula: see text]O2max. CONCLUSIONS We conclude that a contraction in PV does not negatively affect t lim and that rhEPO improves t lim by additional, non-hematopoietic factors.
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Affiliation(s)
- Simon Annaheim
- Exercise Physiology, Institute of Human Movement Sciences, ETH Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.,Laboratory for Protection and Physiology, EMPA, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014, St. Gallen, Switzerland.,Exercise Physiology, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - Matthias Jacob
- Department of Anaesthesiology, University Hospital, Nussbaumstrasse 20, 80336, Munich, Germany
| | - Alexander Krafft
- Division of Obstetrics, Department of Obstetrics and Gynaecology, University Hospital, 8000, Zurich, Switzerland
| | - Christian Breymann
- Division of Obstetrics, Department of Obstetrics and Gynaecology, University Hospital, 8000, Zurich, Switzerland
| | - Markus Rehm
- Department of Anaesthesiology, University Hospital, Nussbaumstrasse 20, 80336, Munich, Germany
| | - Urs Boutellier
- Exercise Physiology, Institute of Human Movement Sciences, ETH Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland. .,Exercise Physiology, Institute of Physiology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland. .,Exercise Physiology, ETH Zurich, Rychenbergstr. 49a, 8400, Winterthur, Switzerland.
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Ventré C, Rousseau S, Albanèse J, Leone M, Martin C. Indications et limites de l'utilisation d'érythropoïétine recombinée en réanimation. ACTA ACUST UNITED AC 2004; 23:714-21. [PMID: 15324960 DOI: 10.1016/j.annfar.2004.02.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 02/16/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyze the data from the literature on erythropoietin and the future indications of recombinant human erythropoietin in intensive care unit (ICU) patients. DATA SOURCE References were obtained from computerized bibliographic research (Pubmed) from 1986 to 2003, except for some physiologic data. DATA SELECTION Original articles, reviews, and letters to editor in French and English were selected and analyzed. DATA SYNTHESIS An anemia is often observed in patients hospitalized in ICU. This anemia may be due to many reasons. The management of anemia consists on the treatment of the underlying disease associated with the transfusion of red blood cells. Recent studies provided evidence of an association between transfusions and mortality in ICU patients. The anemia of ICU patients is compared to the anemia of chronic diseases, which is characterized by a blunted erythropoietin. A treatment with rHuEPO may be a future therapeutic of the anemia in such patients. A multicentric study shows the efficacy of recombinant erythropoietin therapy on a decrease in the use of red blood cell, and another clinical trial highlights a decrease of the proportion of ICU patients receiving red blood cell. Recombinant erythropoietin could be an alternative to transfusion in certain conditions and certain ICU patients. Further studies are needed to determine the consequences on mortality rate and to clarify the place of this therapy in ICU patients.
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Affiliation(s)
- C Ventré
- Département d'anesthésie et de réanimation, centre de traumatologie, AP-HM, CHU Nord, chemin des Bourrelys, 13915 Marseille cedex 20, France
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