Trying to understand the whole Erythropoietin thing

[sandman]

I have some questions about this so please forgive me if I don't have all the facts straight.  Epogen or Eprex is used to help the body produse red blood cells and help elevate your hemoglobin levels, correct?  And the closer your hemoglobin is to normal levels, the more energy you have to perform your normal, everyday chores.  Am I still correct?  I am let to believe that if you have taken to much epogen or eprex, that your blood will become thicker and would clot much easier.  So a doctor would need to keep a close eye on the hemoglobin levels in their patients blood lab results.

From what I gather, hemoglobin levels of 12 to 15 for females and 14 to 17 for males is normal.  Is that correct?  Is that a maximum limit or a healthy persons normal limit?  I have seen a few of Angie's lab results and her hemoglobin was usually with-in the lower end of those boundaries.  One or two that I have seen, were actually just below those limits yet I have never seen her lines run clear.

I know I am missing a point here so maybe someone can explain it to me.  I know that the pink you see in your lines after rinceback is red blood cells but if your taking a form of erythopoeitin to help boost your bodies red blood cell production, why is it so important for the patients to recover every last drop of blood?  And if you take less epogen, wouldn't that lower your energy levels because of a lowered amount of oxygen being carried though your system because of a lack of red blood cells?

[Epoman]

I have some questions about this so please forgive me if I don't have all the facts straight.  Epogen or Eprex is used to help the body produse red blood cells and help elevate your hemoglobin levels, correct?  And the closer your hemoglobin is to normal levels, the more energy you have to perform your normal, everyday chores.  Am I still correct?  I am let to believe that if you have taken to much epogen or eprex, that your blood will become thicker and would clot much easier.  So a doctor would need to keep a close eye on the hemoglobin levels in their patients blood lab results.

From what I gather, hemoglobin levels of 12 to 15 for females and 14 to 17 for males is normal.  Is that correct?  Is that a maximum limit or a healthy persons normal limit?  I have seen a few of Angie's lab results and her hemoglobin was usually with-in the lower end of those boundaries.  One or two that I have seen, were actually just below those limits yet I have never seen her lines run clear.

I know I am missing a point here so maybe someone can explain it to me.  I know that the pink you see in your lines after rinceback is red blood cells but if your taking a form of erythopoeitin to help boost your bodies red blood cell production, why is it so important for the patients to recover every last drop of blood?  And if you take less epogen, wouldn't that lower your energy levels because of a lowered amount of oxygen being carried though your system because of a lack of red blood cells?

The point is that not everyone responds the same to Epogen and some require huge doses just to maintain a lower than normal HCT. For example before I had my thyroids removed I was on a HUGE dose of Epogen 28,000 units 3 times a week, and getting that much epogen barely kept me at 32 HCT, if I was lucky. Which is not bad for a dialysis patient, however not normal. So that is why it was important for me to receive all my blood back by flushing the lines until they are clear. After I had my thyroid and para-thyroids removed I did not even need Epogen for about 6 months, I was given NONE and my HCT got to 50. Which is very high and yes I was at a great risk for clotting. Now I am stable and I receive 5,000 units just once a week and my HCT hits in the 35-38 range. And I do not totally flush my lines anymore as it is not necessary. Also one thing you need to realize is that Epogen does not work instantly, it is a drug that takes time to work in a persons body.

[tamara]

Because of my other health problems other to my kidney problems, I'm on 12,000 units three times a week.

Some doctors in clinic don't look at my complete history and ooh you shouldnt be on that amount , and I say if you wanna change it you better speak to Kathy (my private nephrologist )

[angieskidney]

Sandman:  Here is a link you might find interested Sandman: http://www.medfriendly.com/hematocrit.html

Also, for reference: http://www.dalesplace.net/lab_values.php

HEMATOCRIT (HCT)
Normal Adult Female Range: 37 - 47%
Optimal Adult Female Reading: 42%
Normal Adult Male Range 40 - 54%
Optimal Adult Male Reading: 47
Normal Newborn Range: 50 - 62%
Optimal Newborn Reading: 56

 

HEMOGLOBIN (HGB)
Normal Adult Female Range: 12 - 16 g/dl
Optimal Adult Female Reading: 14 g/dl
Normal Adult Male Range: 14 - 18 g/dl
Optimal Adult Male Reading: 16 g/dl
Normal Newborn Range: 14 - 20 g/dl
Optimal Newborn Reading: 17 g/dl

Sandman, the reason I have to take 10,000 of Eprex 3 x per week is because it doesn't absorb into my body as well as Aranesp does. BUT! My dialysis  unit likes to give everyone in the unit the same thing ... so I used to be on Aranesp when I was on PD but now inclinic HD I am on Eprex (Canadian version of Erythropoietin). So 30,000 per week. Most patients in my unit are on a lot less than that but like Epoman said, everyone is different.

Definition of Hematocrit (Hct): http://www.lifeoptions.org/glossary.php#H
The percentage of red blood cells in whole blood. Normal hematocrit is from 37% to 47% for women and from 42% to 52% for men. The NKF-DOQI recommended target hematocrit range for dialysis patients is 33% to 36% and most patients need regular doses of EPO and iron to stay at this level. Without enough red blood cells to carry oxygen to the tissues, patients feel tired and listless.

And a PDF: http://www.kidneyadvocacy.50megs.com/PDF%20Bin/Lab%20and%20Diagnosis%20in%20Atypical%20HUS.pdf

And if you really want to read the complete drug info sheet on
Epoetin Alfa  -> Pronouncation: eh-POE-eh-tin AL-fuh (Erythropoietin ; EPO )  :
http://www.drugs.com/ppa/epoetin_alfa__erythropoietin__epo_.html



Epoman:  How come Hct is measured in percentage on every site I look at?

[angela515]

I'm not on dialysis now... but I still wanted to ask a question related to epo... so I figured ill post it here.

I am currently taking epo 10,000 units, once a week. Does the new kidney need time to produce epo? Or will it ever produce it?

[kelliOR]

 How come Hct is measured in percentage on every site I look at?

Hct is the percent of red blood cells (erythrocytes) in 1cc of blood.  The rest is compromised of leucocytes, plasma, platelets, and albumin.
Hemoglobin measures the oxygen carrying capacity of the RBC's.  It is a protein on the RBC that enables the cell to carry oxygen.

Kelli

[kelliOR]

I'm not on dialysis now... but I still wanted to ask a question related to epo... so I figured ill post it here.

I am currently taking epo 10,000 units, once a week. Does the new kidney need time to produce epo? Or will it ever produce it?

Angela,

I had to go back on epo when I was about 7 months post txp. Currently taking 20,000 every two weeks. I could have been due to the nephrotoxicity of the prograf.  However, I believe that it is not uncommon to be on epo post txp. I've read that at the most, a transplanted kidney functions at about 60%.

Kelli

[angela515]

Ty kelli, the dr said within the first 6 months it may take awhile for it to start producing it... everything is just so weird this time around, there is a big difference in live donation and cadaver donation... in good and bad ways... The best thing about this time around is its a perfect match, and its working so very well the drs keep telling me how lucky I am to have it and if i take care of it its possible it will last 20+ years... whereas my moms kidney was a 5/6 match and lasted 5 years. With my moms kidney I didnt have to take any supplements or epo... and with this kidney I take epo and phos supplements.

Thanks for the info tho!! 

[Amanda From OZ]

My sister has had her kidney donated to her by my mom More than 11 or so years ago, and she is still taking aranesp. Not to sure why either... Her body is just not producing enough!

I am pretty sure aranesp is the same thing as EPO.

[angieskidney]

My sister has had her kidney donated to her by my mom More than 11 or so years ago, and she is still taking aranesp. Not to sure why either... Her body is just not producing enough!

I am pretty sure aranesp is the same thing as EPO.

Yeah I was on Aranesp til I got switched to Hemo and they put me on Epo (Eprex here) because they like to keep all the HD patients incenter on the same thing to cut cost 

I'm not on dialysis now... but I still wanted to ask a question related to epo... so I figured ill post it here.

I am currently taking epo 10,000 units, once a week. Does the new kidney need time to produce epo? Or will it ever produce it?

I have heard that sometimes a transplant kidney won't do that job so you have to keep taking it

[BigSky]

I know I am missing a point here so maybe someone can explain it to me.  I know that the pink you see in your lines after rinceback is red blood cells but if your taking a form of erythopoeitin to help boost your bodies red blood cell production, why is it so important for the patients to recover every last drop of blood?  And if you take less epogen, wouldn't that lower your energy levels because of a lowered amount of oxygen being carried though your system because of a lack of red blood cells?

It breaks down to this.

The more blood cells you lose the more you need to be made and to get more made you will need more epo to help make them.  As to the dose of epo or Aranesp it depends entirely on how each individual responds to the drugs.

[sandman]

I know I am missing a point here so maybe someone can explain it to me.  I know that the pink you see in your lines after rinceback is red blood cells but if your taking a form of erythopoeitin to help boost your bodies red blood cell production, why is it so important for the patients to recover every last drop of blood?  And if you take less epogen, wouldn't that lower your energy levels because of a lowered amount of oxygen being carried though your system because of a lack of red blood cells?

It breaks down to this.

The more blood cells you lose the more you need to be made and to get more made you will need more epo to help make them.  As to the dose of epo or Aranesp it depends entirely on how each individual responds to the drugs.

Thanks bigsky.  That much, I do understand.  But the fact of the matter is, the patients will have to take epo or aranesp no matter how clear their rinceback maybe.  I guess what I don't understand is, what other effects do those drugs have that I am not aware of.  Will higher doses of epo or aranesp have stronger side effects vs a lowered dose?