Erythropoietin: Functions, Levels, Doses, Side Effects and Risks

It is a hormone that originated in the kidney, which promotes the formation of red blood cells in the bone marrow.

The level of this hormone can be measured in blood tests and is used to detect certain medical conditions.

Erythropoietin can be synthesized and used to treat some types of anemia. It is used to treat anemia resulting from kidney failure or cancer treatment.

It has been considered on many occasions as an alternative to blood transfusions.

The kidney cells that produce erythropoietin are susceptible to the decrease in the oxygen levels of the blood transported through the kidney.

These low oxygen levels may show a decrease in red blood cells, anemia, or decreased hemoglobin molecules that transport oxygen throughout the body.


The primary function of erythropoietin is to stimulate the bone marrow to produce more red blood cells.


The increase in red blood cells increases oxygen transport capacity in the blood.

Among the main functions of erythropoietin are:

  1. Promotes the development of red blood cells.
  2. It starts the synthesis of hemoglobin.

There is a sugar attached to the chemical composition of erythropoietin, so it is a glycoprotein.

This is one of several glycoproteins that serve as growth stimulants for some specific types of blood cells in the bone marrow.

Levels of erythropoietin

It is a hormone that can be detected and measured in blood tests.

Abnormal levels of erythropoietin in the blood indicate disorders of the bone marrow (such as polycythemia or increased production of red blood cells), kidney disease, or erythropoietin abuse.

The blood level test is valuable if:

  • Low levels of erythropoietin could be responsible for the shortage of red blood cells and be related to diseases such as anemia and kidney diseases.
  • High levels of erythropoietin causes too many red blood cells to develop polycythemia and evidence of a tumor in the kidney and disorders in the bone marrow.
  • In athletes, erythropoietin is administered to achieve more excellent athletic performance, so blood levels are checked to detect drug abuse.
  • Normal levels of erythropoietin are between 4 to 24 milliunits per milliliter.

Synthetic erythropoietin

Using new technologies thanks to recombinant DNA, erythropoietin has been synthetically produced to treat certain types of anemia.

This medicine is known as epoetin alfa (Epogen, Procrit) or darbepoetin alfa (Aranesp).

It is administered in intravenous or subcutaneous injections.

The difference between the Procrit or Epogen and the Aranesp is that the latter must be administered less frequently than the Procrit.

All three medications work very well in the treatment of anemia.

Treatment for anemia

Hemoglobin is a substance that is located inside red blood cells and that transports oxygen from the lungs to all tissues of the body.

Anemia can be defined as a condition caused by hemoglobin levels below normal.

Normal levels of hemoglobin occur in the following ranges:

  • From 12 to 16 g / dL in women.
  • From 14 to 18 g / dL in men.

Level of hemoglobin that could cause problems:

  • Mild of 10 g / dL or more.
  • Moderate from 8 to 9.9 g / dL.
  • Graves from 6.5 to 7.9 g / dL.
  • Life threat <6.5 g / dL.

The treatment of anemia in patients suffering from myeloma is complicated because the disease and medicines can cause anemia.

Erythropoietin is a choice in blood transfusions for patients with moderate to severe anemia.

A blood transfusion is necessary when the patient does not respond to treatment with erythropoietin.

There are cases in which therapy with erythropoietin can be considered for mild anemia (hemoglobin 10 to 11 g / dL) in patients who meet the following characteristics:

  • With advanced age and heart or lung problems.
  • With atherosclerosis.
  • They suffer from pain and chest angina.

Clinical trials have reported that in the treatment of anemia associated with cancer, supplying erythropoietin produces the following effects:

  • A significant improvement in the patient’s quality of life, including the ability to perform their usual activities.
  • Reduces the need for transfusions in patients receiving minimal chemotherapy.
  • It can decrease anemia in patients who have cancer.

Side effects

Erythropoietic treatments are generally well tolerated.

However, recent studies have shown that its administration is associated with an increased risk of blood clots.


The most common initial dosages for treatment with the various types of erythropoietin are listed below:

  1. Procrit or Epogen: 150 units per kg three times a week or a single weekly dose of 40,000 units.
  2. Aranesp: 2.25 mcg per kg once a week or 500 mcg every three weeks

The dose can be modified depending on the response to therapy.


When it is not administered correctly and is combined with vigorous exercise, it can increase the viscosity of the blood in case of dehydration.

This increases the risk of the appearance of blood clots and the occurrence of heart attacks and strokes.