Erythropoietin: instructions for use of the solution. Erythropoietin recombinant human Erythropoietin structural formula

On the eve of the last Olympics in Beijing, the head of the Russian anti-agency RusADA, Alexander Drevevoedov, answering the question of what drugs the domestic laboratory catches most often, named first of all diuretics, steroids and marijuana, the fascination for which has recently become a real scourge in many sports around the world . But all the loudest of this winter brought to light the abbreviation EPO, which is much more mysterious for the layman. Traces of this particular substance were found in the analyzes of the three leaders of the national biathlon team Albina Akhatova, Ekaterina Yurieva and Dmitry Yaroshenko. And a little later, a number of fairly well-known athletes - biathletes Andrei Prokunin and Veronika Timofeeva, multiple winners of the World Cup stages according to Natalia Matveeva, as well as athletes Vladimir Yezhov and Elena Canales.

By the way, even before the 2006 Winter Olympics in Turin, the then head of the Anti-Doping Service of Rossport, Nikolai Durmanov, spoke of EPO as a real nightmare for world sports. According to him, due to the fact that the drug was elusive for many years, he, in fact, “determined the design of sports pedestals”: who is at the top, who is a little lower, and who did not make it to the number of winners. This was especially true of sports such as cycling, cross-country skiing, many talked about ... But even today, when the drug has already been learned to catch, experts in the field of pharmacology still emphasize that EPO stands apart in the list of prohibited substances of the World Anti-Doping Agency (WADA) .

In the body of each person there is this very erythropoietin - a hormone that makes up for the lack of blood cells. If a person climbs into the mountains, then there he begins mountain sickness - there is not enough oxygen. At this point, EPO begins to be produced as a response. If you prick EPO below, at a normal height, then the body will respond as if a person were in the mountains. The amount of hemoglobin in the blood will increase dramatically in a few hours, therefore, the blood will be better saturated with oxygen, muscles will work better, endurance will increase ... This drug was invented in the USA in 1983 for the treatment of kidney patients and is almost an exact copy of the natural hormone, which, in fact , made and continues to make it difficult to catch. EPO entered the sport two years after the invention of the drug. Moreover, with reasonable use, it is practically harmless to the body. As one of the authoritative experts in the field of sports medicine told NI, if the word “humane” is applicable to doping, then, unlike the same anabolic steroids, EPO can be called humane doping. The danger lies in the fact that in large doses and with severe dehydration of the body (imagine how much moisture a cyclist loses during a race in the mountains), it poses a real threat to health, and sometimes life due to an increase in blood viscosity and the possibility of thrombosis, especially in those whose body is naturally inclined to it. The former head of the Russian anti-doping laboratory, Vitaly Semenov, once said that he personally did not know cases of death among athletes after the use of EPO, but at one time he had to observe three cyclists who played for professional Italian clubs. One of them, weighing 80 kg, after taking five cycles of EPO within a year, lost half his weight, and he developed serious health problems.

Few people know that the international Olympic movement first sounded the alarm about EPO back in 1988 during the Calgary Olympics. However, a substantial amount of 400 million dollars had to be invested in the program for its “development”, and Juan Antonio Samaranch, the then president of the IOC, could not go to such expenses. Saying "thank you" for the discovery of EPO should be two French specialists from the laboratory in Chatenot-Malabri, who in 2001 learned to distinguish artificial EPO from natural. And the result was not slow to tell. Despite the fact that cyclists were considered the discoverers of miracle doping, the first high-profile EPO scandal broke out at the 2001 World Ski Championships, when traces of the drug were found in six athletes of the Finnish national team at once. A year later, at the 2002 Olympics in Salt Lake City, Russian skiers Larisa Lazutina and Olga Danilova, as well as Spanish rider Johan Myulegg, caught on it. Two years ago, a talented Russian skier, Sergei Shiryaev, was charged with using the drug, and his two-year ban just ended this winter. And last summer, we recall, a loud scandal shook the holy of holies of cycling - the Tour de France.

Ekaterina Yurieva fell for the EPO.
Photo: AP

Currently, there are several types of EPO and its derivatives. For example, American-made - darbopoetin, because of which Lazutina and Danilova suffered, or the Swiss drug sera, discovered on the Tour de France ... In addition to American and European analogues, three types of EPO are produced in China, two - in our country. Versions that some of them are detected better, and some are worse, as one of the employees of the Russian anti-doping center confirmed to NI, do not correspond to reality. Although, as the next novelty appeared on the market, there was talk of its elusiveness. All types of EPO are about the same in effectiveness, and all are detected. But they differ in structure, time of action in the body and price. Russian EPO, for example, will cost less, but to conclude that it was for this reason that those who injected the substance to our biathletes were pierced (in the analyzes of Akhatova, Yuryeva and Yaroshenko, according to some reports, a drug of handicraft Russian production was found) is not costs. Today, a domestic drug is presented as a synonym for the poor work of home-grown pharmacologists, but if it is produced in a normal, non-artisanal way, there will be no significant difference compared to its counterparts in terms of efficiency, and the speed (or vice versa) of detection will not have any. There are long-playing EPO, there are those that act for a short time. Pharmacologists say that if you make an injection once, but more powerful, then the chances that the drug will be caught increase significantly. So those who are trying to cover their tracks prefer to inject more often, but less.

Such a popular use of EPO in sports is also due to the fact that artificial erythropoietin quickly breaks down. It can be detected in the body of an athlete within two to three days, a maximum of four, but this is already considered an exception. By the way, I happened to hear a version that it was for this reason that Matveeva was released to international competitions, which, as it turns out now, has not passed internal Russian control. Hoped for a chance, but did not carry. From a purely medical point of view, one of the most popular questions about doping today can also be answered: why do some people get caught and others do not? Different people have different periods of elimination of this drug, and there are those who have the presence of EPO in the body to identify and prove 100% impossible. That is why, as a rule, a test for erythropoietin is sent for analysis only when there are serious grounds to suspect the athlete of using this drug. Changes in the blood, for example. It is for this reason that a special dossier is created for athletes, where all blood parameters are entered - even if EPO leaves the body in two days, the effect on the blood remains noticeable for weeks, which gives the laboratory reason to suspect something was wrong. Although, as an authoritative source noted in a conversation with NI, sometimes the presence of a desire or, conversely, unwillingness to catch someone specifically from representatives of the anti-doping services cannot be denied either. Research on EPO, by the way, is very expensive, requires a long time, and sometimes, to be completely sure, and the help of colleagues from other laboratories.

From the list that is on the WADA list today, the Moscow Anti-Doping Laboratory determines everything, including EPO. True, only the last two months in the Federal State Unitary Enterprise "Anti-Doping Center" testing for EPO is carried out on a regular basis. During this time, four positive samples were identified. But if you look at the example of the same Matveeva, sometimes the internal control does not stop either athletes, or coaches, or heads of federations. Doping, to be honest, today still remains an integral part of the sports world. There is a demand for it. The danger is that the specifics of the illegal sports market are such that there is no need to wait for certificates and approval from the Russian Ministry of Health. Experimental drugs can easily penetrate sports, and darbopoetin, which began to be used in sports earlier than in medicine, confirms this. The same can happen with gene doping - the new headache of big sport. By the way, Durmanov has repeatedly said that even a small, well-equipped laboratory can set up its production. At the same time, it is useless to frighten athletes - they are not afraid of anything. This is the profession of desperate people. They are used to living in a risk zone.

According to experts, there is only one way out - to offer an alternative to doping. The most annoying thing is that even now in Russia, where the level of sports medicine remains weak, primarily not because of the lack of good doctors, but because after the collapse of the USSR, a new system of medical control and provision of athletes has not been built, alternative programs, doping-free achievement results exist. These are, for example, a range of physical, chemical and pharmacological methods in any combination with the use of approved drugs that came from previously closed areas - extreme activities, military training and space. It's just that for some reason they don't get the attention they deserve. Although one of the reasons lies on the surface. These methods are more expensive, and you won’t earn much on them. True, there are already those who are not afraid to "risk". For example, there are several successful examples of such programs in the national swimming team. But within the framework of big Russian sports, this is a drop in the ocean. Those who today undertook to reform Russian sports should think that such training has become the norm.

Latin name: Erythropoietin
ATX code: B03XA01
Active substance: epoetin beta
Manufacturer: Binnopharm, Russia
Vacation from the pharmacy: On prescription
Storage conditions: darkness, dryness
Best before date: two years.

Erythropoietin is a lyophilizate from which a solution is prepared for intramuscular or intravenous administration. An agent based on epoetin beta is a recombinant renal hormone that increases the number of reticulocytes, red blood cells in the blood and promotes the formation of hemoglobin in cells.

Erythropoietin is used for all kinds of anemia. In case of intolerance to the drug or its improper use, a heart attack or stroke may develop. Therefore, the drug is released only for medical purposes.

Composition and form of release

Erythropoietin is produced in the form of a dry concentrate, from which a solution is prepared for intramuscular or intravenous administration. In 1 ml of the medicinal liquid is epoetin beta in the amount of 2000 IU or 500 IU.

Secondary composition:

Isotonic citrate - E 330
Natrii chloridum
E 331
Albumin protein solution.

The colorless solution is placed in ampoules (1 ml each). A pack of thick paper can contain 5 or 10 ampoules.

Another form of release of the drug is Erythropoietin alfa. The solution contains 20,000 or 10,000 IU of epoetin.

Additional components:

E 433
injection water
Sodium hydrogen phosphate
Sodium chloride.

The colorless solution is packaged in ampoules (10,000 units), vials (10,000 units, 4,000 units, 2,000 units), syringes (1,000 units - 4,000 units).

Pharmacological properties

Epoitin beta is a glycoprotein that activates mitosis, erythropoiesis and promotes the formation of red blood cells. Recombinant erythropoietin is produced in vertebrate cells where a gene that blocks human epoitin has been inserted.

Epoetin beta is similar to erythropoietin produced in the human body. After application of the solution, hematocrit and hemoglobin values increase.

If epoetin beta is used in the treatment of young women, then their menstrual cycle is getting better. But the risk of pregnancy also increases, so contraceptives must be used during treatment.

The use of Erythropoietin stimulates blood circulation in tissues and improves cardiac activity. The introduction of Epoetin is effective in anemia that occurs against the background of renal failure. However, with prolonged use of the drug, neutralizing antibodies to its components may form, followed by the occurrence of erythroblastopenia.

With the / m use of the solution, the half-life takes up to 6 hours. With prolonged use of the drug, the content of its basic components in plasma becomes maximum 12-28 hours after use. T ½ - from 13 to 28 hours.

With the / in the introduction of T1 / 2 takes 4-12 hours. With i / m use, bioavailability is 25-40%.

Indications and contraindications for use

Erythropoietin is used for prophylactic and therapeutic purposes in anemia of various etiologies, including hematological syndrome in CRF and IDA in patients on hemodialysis.

Also, the remedy is used for anemia, accompanied by the following conditions:

multiple myeloma
Presence of large tumors treated with chemotherapy
lymphocytic leukemia
Erythropoietin deficiency.

Erythropoietin is prescribed to increase the amount of donated blood for blood transfusion. Also, the solution is used to prevent anemia in premature babies.

Contraindications:
Epoetin intolerance
heart attack
Pregnancy
Severe vascular pathologies
Stroke
Erythroblastopenia that occurs after taking epoetin
porfiria
Thrombosis
Hypertension
Lactation.

Treatment will be ineffective in case of iron deficiency, acute inflammatory or infectious process and hemolysis, in which hemoglobin is released.

Instructions for use

The cost of the medicine is from 7300 rubles. The price of the medicine is from 4422 rubles.

Instructions for use states that Erythropoietin is used in / in or s / c. Intravenous administration of the drug should last about two minutes. In hemodialysis, the drug is used at the final stage of the procedure and is administered through an arteriovenous shunt.

In chronic renal failure and anemia in adults, Erythropoietin is administered subcutaneously three times a week. Dosage - 20 IU / kg. If the hematocrit is less than 0.5%, then the amount of the drug is increased by 20 IU / kg every 30 days. The maximum dose is 720 IU/kg.

With maintenance treatment, the initial amount of Erythropoietin with a hematocrit of 30% is achieved by administering a dosage of ½ of the previous injection. Then the dose is selected for each patient individually. Dosage adjustments are made every 7-14 days.

With anemia in children, the dose is selected based on the age of the child. The duration of therapy is lifelong. You can stop treatment at any time.

Dosage of Erythropoietin:

Anemia in premature babies - IM 250 IU/kg three times a week. The medicine begins to be used on the 3rd day after birth. The therapy lasts one and a half months.
Anemia in tumor-like formations - 450 IU / kg once a week. If treatment fails, the dose may be doubled. Therapy time is up to 21 days.
Anemia in multiple myeloma, leukemia, lymphoma - s / c 450 IU / kg once every 7 days or 3-7 times a week. If necessary, the dose can be increased to 900 IU / 1 kg.

In preparation for transfusion of one's own blood, Erythropoietin is administered by any method twice a week for one month. When the hematocrit is more than 33%, then the solution can be administered at the final stage of the procedure.

The highest dose per week for intravenous administration is 1600 IU / 1 kg of body weight. The maximum amount for i / m use is 1200 IU / 1 kg.

Erythropoietin is often used in bodybuilding for better tissue nutrition. The amount varies from 50 to 300 IU / kg. Erythropoietin in sports can be used continuously for no more than 1.5 months.

Side effects, overdose, interactions

Due to the / m or / in the administration of the drug, erythropoietins can provoke a number of negative reactions. These are hyperkalemia, encephalopathy, thrombocytosis, migraine, anaphylaxis.

Other side effects:

Skin rashes
Chills
Cloudy mind
Hypertension
convulsions
Fever
Ossalgia
Dyslalia.

An overdose is manifested by a sudden increase in hematocrit and hemoglobin in the blood, hypertension, erythrocytosis. Treatment consists of using phlebotomy and removing excess fluid from the body.

Interaction of Erythropoietin with other drugs:

Medicinal solutions - may reduce the effectiveness of epoetin
Cyclosporine - increase the binding of red blood cells, which requires dose adjustment.

Analogues

Manufacturer - Roche Diagnostic, Germany

Price– from 1060 rubles

Description - the solution is used for the treatment and prevention of anemia

pros– can be transported without a refrigerator, efficiency

Minuses- price, many side effects, after administration, local negative reactions often occur in the form of itching, redness and swelling, can provoke a stroke or heart attack.

Producer - Pharmapark, Russia

Price– 3800 rubles

Description - the solution is used for anemia that occurs in premature babies, with malignant tumors, multiple myeloma, leukemia, erythropoietin deficiency

pros- quickly eliminates signs of anemia, increases blood circulation in tissues

Minuses- cost, ampoules are inconvenient to open, can not be used for diseases of the heart and blood vessels.

The hormone erythropoietin regulates the formation of electrocytes (red blood cells), which are synthesized in bone marrow stem cells. This biologically active substance is produced by the kidneys and, to a much lesser extent, the liver, and its production is affected by the concentration of oxygen in the blood: when its level begins to decrease, the amount of erythropoietin increases and stops increasing as soon as the body is saturated with oxygen.

Erythroepin is considered a physiological stimulant of erythropoiesis (this is how one of the processes of hematopoiesis is called). Its production begins immediately, as soon as oxygen begins to flow to the tissues of the body in an excessively small amount (it is carried mainly by the complex iron-containing protein hemoglobin).

It is worth noting that the role of oxygen is extremely important, since it is with its participation that the energy necessary for the life of the body is produced. It takes part in oxidative processes, as well as in various metabolic reactions, including the synthesis of cholesterol, bile acids, steroid hormones, and biologically active products of amino acid metabolism. Also, its presence is necessary for the neutralization of poisons, toxins, drugs.

If the amount of oxygen in the blood decreases and is not restored, hypoxia occurs, which leads to violations of the biochemical processes of tissue respiration. Particularly affected are the muscles of the heart, the central nervous system, the kidneys and the liver.

To prevent irreversible consequences, the kidneys, in response to oxygen starvation or ischemia (circulatory disorders), produce erythroepin to stimulate erythropoiesis. The hormone, having entered the bloodstream, activates the conversion of reticulocytes into red blood cells. As a result, hematopoiesis increases, and more red blood cells are released into the blood.

As a result, the level of oxygen in the blood rises, which leads to better nutrition of cells, respectively, makes the body more resilient. In addition, under the influence of erythropoietin, systemic arterial pressure rises, and due to the increase in erythrocyte mass, blood viscosity increases.

Also, the kidneys increase the production of the hormone in case of blood loss, any form of anemia, with insufficient blood supply to the kidneys. The concentration of erythroepin in the blood may increase under the influence of glucocorticoids. This is the name of the hormones that the adrenal cortex produces, the production of which increases in stressful situations. An increase in erythropoietin in this case leads to an increase in the amount of hemoglobin and the oxygen-supplying capacity of the blood during stress.

Another effect of the hormone on the blood is that under its influence the bone marrow increases the consumption of iron, copper, vitamins B9, B12. This leads to a decrease in these elements in the blood plasma, as well as to a decrease in transport proteins: feritin, which is responsible for storing iron in the body, and transcobalamin (B12). Therefore, you need to take care of your diet and make sure that the right amount of vitamins and minerals enters the body every day.

Above and below normal

The concentration of erythropoietin in the blood of a healthy woman ranges from 8 to 30 IU / l, in men these figures range from 5.6 to 28.9 IU / l. Deviations from the norm make the doctor alert and prescribe an additional examination to determine the cause.

For example, if the level of erythropoietin is elevated, and the number of red blood cells is reduced (this is despite the fact that the hormone contributes to their production), this indicates the development of anemia (anemia), which provoked inhibition of bone marrow function. If, with anemia, the tests showed a reduced amount of the hormone, this indicates that the kidneys synthesize its production less than normal.

In addition to comparing these analyzes, hormones and the environment have an increase or decrease in erythropoietin. For example, a high concentration of estrogen in the blood reduces the production of erythropoietin, while thyroid hormones, somatropin, testosterone, prostaglandins, and glucocorticoids increase it. Also, erythropoietin increases due to smoking, low partial air pressure, stay in the highlands.

A reduced amount of erythropoietin indicates problems with the kidneys, primarily chronic renal failure (therefore, people with this disease suffer from anemia). It also speaks of the disease polycythemia. This is the name of a malignant tumor characterized by the growth of all cellular elements of the bone marrow.

The increased content of erythropoietin makes the blood thicker, clogs small vessels, leads to disruption of the blood supply to the brain and heart, which is extremely dangerous for the life of the body. Exceeding the norm may indicate the following diseases of the skeletal system:

blood loss;
various forms of anemia;
pure aplasia of the red bone marrow - the bone marrow produces leukocytes and platelets within the normal range, erythrocytes - below acceptable limits;
the initial stage of myelodysplastic syndrome - the disease is characterized by dysplastic changes in the bone marrow, combined with a lack of one or more types of blood cells, can develop into acute leukemia;
leukemia.

Another reason for the increased content of the hormone is kidney disease, which produces erythropoietin. First of all, the amount of the substance increases in violation of the blood supply to the kidneys due to shock, urolithiasis, polycystic kidney disease, narrowing of the renal artery.

Some diseases that provoke an increase in erythropoietin cause a decrease in blood oxygen saturation. These are heart defects, congestive heart failure, and various lung diseases. Among them are chronic bronchitis, pneumoconiosis (incurable lung diseases provoked by prolonged inhalation of industrial dust), chronic obstructive pulmonary disease, characterized by airflow limitation in the respiratory tract.

An increase in erythropoietin in the blood can also signal the presence of a benign or malignant formation. It may be a malignant tumor of the central nervous system known as hemangioblastoma. The concentration of the hormone also increases in kidney tumors and pheochromocytoma (a tumor in that part of the adrenal cortex that is responsible for the synthesis of the hormones adrenaline and norepinephrine).

Doping in sports

Another reason why an increased amount of the hormone can be detected is the use of artificial erythropoietin in sports as a doping. Since the number of red blood cells increases under the influence of the hormone, the blood begins to flow more intensively to all cells of the body, saturating them with nutrients and also energizing.

A drug with a hormone analog is especially popular in sports that require aerobic endurance - the ability of a person to do work of moderate intensity for a long time while functioning of the entire muscular system and quickly recover after completing the activity.

Oxygen in this type of activity is necessary to convert carbohydrates into energy, with particularly prolonged loads, the body uses proteins and fats for this. Such sports include cycling, long and medium distance running, cross-country skiing.

But there is also a negative side to the use of a hormone analogue: recombinant erythropoietin in increased quantities depletes the body's strength, disrupts its work and can lead to death. Therefore, after several deaths among cyclists, the drug was classified as a doping drug in 1990, after which erythropoietin was banned from sports.

Athletes who continued to use it after the ban were disqualified. This is exactly what happened in 2012 to the world famous cyclist Lance Armstrong: after discovering that he was doping and distributing it among athletes, the athlete was banned for life and stripped of all the awards he had won since 1998.

Determining the presence of alpha erythropoietin in the body is not easy, since it is very similar to the natural hormone. The drug obtained by genetic engineering coincides with natural erythropoietin in the composition of amino acids, but has differences in the structure of glucose elements.

Therefore, anti-doping laboratories use different methods to detect doping in the blood. For example, in cycling, a limit was introduced on the permissible level of hemoglobin, which is responsible for transporting oxygen to cells.

If during the doping control the amount of hemoglobin in the blood exceeds the norm, the cyclist is suspended from the competition. It cannot be denied that this is a very subjective indicator, largely dependent on the individual characteristics of the body, and hemoglobin above the norm does not always indicate the use of a prohibited drug.

Effective treatment

Erythropoietin analogue is produced by many pharmaceutical companies in five forms: alpha, beta, omega, retard, theta. Alpha and beta are the earlier preparations, theta hormone is considered the most effective: it is the least allergenic, and has the best cleaning. More than other analogues, erythropoietin omega differs from the human hormone, therefore, when testing for doping, it is easier to detect it than others.

Preparations that contain erythropoietin are produced by various companies, so they are quite different in effect from each other. Because of this, when switching from one drug to another, you need to study the instructions for use. If you use recombinant erythropoietin according to the instructions and prescriptions of a doctor, you can achieve good results in the treatment of many ailments, among them:

chronic renal failure;
malignant tumors;
AIDS;
transplantation of tissues and organs;
autodonation - the process of donating and preserving the patient's blood before a planned operation, during which blood loss is possible;
pre-and postpartum period without auto-donation;
various forms of anemia;
refusal of a blood transfusion.

When using erythropoietin preparations, it must be taken into account that even the smallest fraction of the hormone has a huge impact on the body, since it affects changes in the rate of synthesis of this substance. Before using erythropoietin alfa, beta and other drugs, you must not only carefully follow the doctor's instructions, but also carefully study the instructions for use.

The instruction provides for subcutaneous and intravenous administration of alpha erythropoietin. The purpose of using the drug is to achieve a level of blood cell volume in the blood from 30 to 35% and hemoglobin from 110 to 120 g / l (not higher). Blood for control to donate during therapy with alpha erythropoietin should be done once a week.

If there is a need to increase the dose, the instruction allows you to do this no more than once every half a month, for each ailment there is a maximum dose per week, which is not recommended to be exceeded. At the final stage of treatment, the dose is gradually reduced. When using the dosage of alpha erythropoietin indicated in the instructions, it should be borne in mind that the use of other drugs may include the rate of use.

If the tests show that erythropoietin has increased by more than 20 g / l within four weeks, the dose of alpha erythropoietin, according to the instructions, must be reduced. If the patient has high blood pressure, cardiovascular diseases, as well as ailments associated with impaired cerebral circulation due to damage to the cerebral vessels of the brain, the erythropoietin analogue should be prescribed with caution.

When using alpha erythropoietin, one must be prepared for the fact that two months after the hemoglobin level is normal, the analysis may show a lack of iron, folic acid, vitamin B12. This can be easily corrected with the help of a vitamin-mineral complex.

What is erythropoietin? Erythropoietin is a hormone that enters the bone marrow, where red blood cells appear. Their basis is stem cells. Red blood cells contain hemoglobin. Erythrocytes exist for about 4 months. They all have the same shape and size. In every organism there is the same number of red blood cells that move through the bloodstream.

If many of these cells are produced, then most of them are destroyed or lost during blood loss. Along with this process, the volume of oxygen begins to decrease, which was received by the internal organs and tissues. Through this process, erythropoietin is produced.

The role of the hormone

This hormone is of great importance for people involved in sports. With regular physical exertion, oxygen starvation appears, which is why the hormone begins to be produced in large quantities in order for the activation of the bone marrow to create red blood cells.

But the appearance of these cells depends not only on the bone marrow, but also on the required amount of iron, vitamin B12 and folic acid in the body. The very process of creating red blood cells is no less important. If erythropoietin is lowered, then there will also be no incentive effect on the bone marrow.

To determine the hormone and its level, a blood test is required. Its norm is from 4.3 to 29 mIU / ml. If the results do not correspond to these coefficients, then there is a disease. If the level of the hormone is elevated, and the results of the tests show a lack of red blood cells, then the person has anemia, which appeared due to the insufficiency of the bone marrow.

If the hormone erythropoietin is lowered due to anemia, then there is a nervous work of the kidneys. It is these organs that are responsible for the formation of erythropoietin.

If erythropoietin is elevated with erythrocytes, then it is secreted by any internal organ. And if only erythrocytes are elevated, when the level of the hormone began to decrease, then polycythemia has nothing to do with the production of the hormone.

The structure and significance of erythropoietin

One hormone molecule is made up of amino acids. If there is an intense decrease in hemoglobin and red blood cells in the blood, then the body lacks androgenic erythropoietin. As a result, a disease called erythropoietin deficiency anemia begins to develop. Previously, there were no drugs to cure this disease, but now experts prescribe recombinant erythropoietin.

Pharmacists obtain this medicine from animal cells, it is similar in composition to a suitable hormone. The biological activity of the resulting substance is absolutely the same as the endogenous hormone. According to scientists, epo is associated with specific erythropoietin-sensitive receptors that are located on cells.

Recombinant erythropoietin purification method

If the hormone cannot be produced on its own in the right amount, specialists are required to prescribe drugs that will help the body bring this hormone back to normal.

One of these drugs is recombinant. Recombinant human epo is one of the best known proteins that is being created by various biological and pharmaceutical companies in the world for drug treatment.

This compound is produced by Chinese hamster ovary cells using recombinant DNA. In one polypeptide chain of recombinant EPO there are more than 165 amino acids, its mass is 24000 Da, and the mass of glycosylated protein is 30400 Da. As for human EPO, it has its own degree of purity, which is 98%.

This drug is prescribed for anemia, the cause of which is:

chronic renal failure;
bone marrow damage;
other chronic diseases.

This drug should be well studied. The instructions for use have a special section for the use of its newborns who were premature. And this means that they definitely need the prevention of anemia.

With this medicine, you can increase the level of donated blood, which is exploited for autotransfusion. Particular attention should be paid to contraindications. Before use, be sure to consult a doctor.

Contraindications for use:

hypersensitivity to any component of the drug;
severe form of arterial hypertension;
unstable angina;
uncontrolled arterial hypertension;
thromboembolism;
pregnancy and lactation;
inability to conduct effective anticoagulant treatment.

As for the dosage and duration of treatment, all this is prescribed only individually. The doctor looks at the type of anemia, the patient's condition and the characteristics of the pathology. The drug is administered intravenously. At the beginning of treatment, doses should be no more than 50-150 IU per kilogram of body weight. And also the dosage varies depending on the age of the patient. The hormone should be administered no more than 3 times a week. With an overdose, the side effects are more intensified. After a course of treatment for about 3 weeks, the result becomes apparent, the patient's condition improves.

Side effects

Side effects are more enhanced with self-increasing doses:

dizziness;
drowsiness;
headache;
arthralgia;
chest pain;
tachycardia;
convulsions;
eczema;
rash and itching of the skin;
hives;
vomit;
diarrhea;
asthenia.

If a person uses this drug in order to increase donor blood, then it is undesirable for people who have had a heart attack or stroke.

Recombinant erythropoietin analogues

In order for the processes of erythropoiesis to be activated, specialists began to use various medicines:

Aranesp;
Epobiocrine;
Vepoks;
Epocrine;
Epogen;
Hypercrit;
Erythrostim;
Epostim;
Epoetin Beta;
Epozino;
Recormon;
Eralfon;
Epomax;
Eprex;
Gemax;
Binocrit;
Bioein;
Aeprin.

To replace the recombinant with another similar drug, consultation with a specialist is required.

Causes of the external indicator

Processes in which the hormone is elevated:

iron deficiency anemia with low hemoglobin;
consequences of chemotherapy;
malignant or benign tumor of the cerebellum;
kidney transplant rejection;
kidney cyst;
various malignant tumors;
lung disease;
kidney failure;
rheumatoid arthritis.

Reasons why this figure is lowered:

oxygen starvation;
urolithiasis;
polycystic kidney disease;
myeloma;
polycythemia.

Hormone replacement therapy is prescribed by a doctor only after an in-depth study and thorough diagnosis of the disease.

Analysis

A blood test for erythropoietin is prescribed only if the following diseases are present:

chronic kidney failure;
anemia in people who have kidney failure;
athletes (the use of erythropoietin is equated to doping).

Elevated erythropoietin is observed in people who have pronounced symptoms:

dizziness and severe headache;
itching after washing;
bleeding;
cyanosis;
enlargement of the spleen;
purple skin of the face;
visual impairment;
shortness of breath in a horizontal position.

This hormone rises due to the large number of red blood cells. They contribute to thickening of the blood and clogging of small vessels.

If the level of the hormone is low, the person suffers from the following symptoms:

pale skin;
fatigue;
fatigue;
low hemoglobin;
shortness of breath with minor physical exertion.

The norm of erythropoietin in human blood

In women, the norm of this hormone is from 11 to 30, and in men from 9.6 to 26.

Important to remember! All laboratories have their own standards for the level of this hormone. It depends on the equipment that is installed there. In the form, when the results of the study are ready, you can view the column in which the rate of erythropoietin will be indicated.

Analysis for erythropoietin is carried out only in combination with the following studies:

a general blood test, where the focus is on the number of red blood cells, hemoglobin;
general urine analysis;
kidney tests: urea and creatine;
cancer-embryonic antigen;
liver tests: ALT, AST, GGT, alkaline phosphatase, bilirubin;
folic acid;
blood test for reticulocytes;
ferritin;
transferrin;
alpha-fetoprotein;
serum iron;
vitamin B12.

The level of this hormone is predetermined in order to assess the regulation of hematopoiesis of an erythrocyte germ.

The following factors may affect the results of the analysis:

smoking;
reduced estrogen.

This hormone enriches the body with oxygen. Therefore, a person can withstand quite serious physical exertion for a long time. After the athlete has received a certain dose of this hormone, he becomes more enduring.

Erythropoietin has its popularity more in skiing, running, cycling and athletics. Now this drug has been banned and is considered undesirable for increasing endurance for the human body.

If the drug was administered in small doses. You may not notice it, but, nevertheless, it has a completely different chemical formula in comparison with the natural hormone. If the doses of the drug are regularly overestimated, then there can be serious consequences that will affect human health. There may be a violation of the composition of the blood, which will lead to oxygen starvation of the brain.

If a person has chronic kidney disease, the level of erythropoietin will be permanently elevated. The specialist, in turn, must control it, with the help of regular delivery of the necessary tests.

A patient who has all of the above problems should be registered with a dispensary, constantly undergo treatment in order to avoid recurrences of the disease.

Additional intake of this drug must be discussed with the doctor, as well as the dosage.

This hormone is very important for the human body. All its functions should be explained by the attending physician.

The hormone erythropoietin is produced by cells in the kidneys and, to a lesser extent, in the liver. It has been studied since 1905 from the time when the French doctor of medicine Paul Carnot began to study it. He then wrote the first work on the topic - erythropoietin, what it is. Briefly, it is a lycoprotein hormone associated with the function of hematopoiesis. How it works and what its deficiency or excess in the body leads to can be found further.

Erythropoietin is produced in a situation of hypoxia, or oxygen starvation at the molecular level. After entering the bone marrow, erythropoietin starts the process of synthesis of red blood cells, or erythrocytes. And already erythrocytes begin to carry the much-needed oxygen to all human organs.

The number of red blood cells in the blood is constantly decreasing due to their short life, something like 3 months. And with a decrease in their number, the oxygen content in the body also decreases. Therefore, the hormone erythropoietin is necessary for a person constantly to renew red blood cells and maintain their quantity in the blood at the required level.

We should not forget about extreme cases of lack of oxygen, for example, with a large blood loss, or significant physical exertion, when the need for oxygen increases significantly.

You also need to understand that erythropoiesis, the process of hematopoiesis, cannot proceed without “building material”, in this case iron, vitamin B12 and folic acid. So along with EPO, a person should consume a sufficient amount of these elements with food or in pure form in tablets or injections.

The norm of erythropoietin in the blood of a healthy person should be 4.3 - 29 mIU / ml. But with prolonged physical exertion, this rate increases several times. This phenomenon occurs in the organisms of athletes or people engaged in hard physical labor. In their bodies, the hormone must be produced constantly and in large quantities.

Any violation of the level of erythropoietin indicates that some kind of pathology takes place in the body. The person began to have problems with the kidneys, liver, bone marrow, or metabolism. In any case, for an accurate diagnosis, a blood test for erythropoietins is done and the internal organs are studied.

Blood test

An analysis for erythropoietin is carried out in order to determine the patient's signs of anemia and its type. This condition is characterized by a low content of red blood cells and, accordingly, erythropoietin.

Anemia can be moderate or severe. The latter condition is dangerous because without proper treatment, the patient's condition will worsen due to a constantly progressing disease.

The analysis is carried out regularly in cases of chronic kidney or liver disease. Such monitoring of the state of the blood is necessary in order to prevent a sharp deterioration in the condition of a person.

With a high content of red blood cells in the blood, an analysis for erythropoietin is also prescribed. After all, it is important to find out what was a surge in hormone activity. And besides, an abundance of red blood cells in the blood can cause thrombosis, which can ultimately lead to blockage of a large vessel and death of a person.

Elevated erythropoietin

An elevated erythropoietin level with a low red blood cell count is much more common than the reverse.

This condition can be caused by various pathologies:

A rare disease is pure aplasia of the red bone marrow. It is characterized by a low content of erythrocytes, while the level of leukocytes and platelets remains normal.
Chronic blood loss leads to a high content of erythropoietin in the blood. For example, with weak bleeding from the anal sphincter or gastrointestinal diseases.
Anemia can be caused by a lack of trace elements involved in the construction of red blood cells. These are folic acid, iron, vitamin B12. That is, there is a lot of hormone in the bone marrow, but there is nothing to build blood cells from.
Some type of leukemia can develop in the body.
Since erythropoietin and other hormones are produced in the kidneys and adrenal glands, elevated levels of these substances in the blood can be caused by the appearance of a tumor in the kidney. In general, any damage to the kidneys leads to a violation of the level of erythropoietin - a compression blow, rupture of an artery, and so on.
The level of erythropoietin increases in chronic bronchitis, or another viral disease.
An overdose of the hormone leads to heart failure and blood stasis.

In general, to determine the cause of an elevated erythropoietin content, a person must undergo an almost complete examination of internal organs and blood vessels using various medical equipment - ultrasound, ECG X-ray, computed tomography, and so on.

Decreased erythropoietin content

Reduced erythropoietin content is much less common and causes a very limited number of pathologies:

Chronic renal failure is the main reason for the decrease in the content of erythropoietin in the blood.
The dialysis procedure also reduces the content of erythropoietin, but in this case, the norm is quickly restored.
In diseases of the bone marrow, namely proliferation, the amount of the hormone in the blood does not play a role. So it goes down on its own.
The intake of certain steroid-type drugs can lower the content of erythropoietin.
Pregnancy is often accompanied by a low content of erythropoietin.

Testing for erythropoietin

In order for the result of the analysis for erythropoietin to reflect the real picture, a number of conditions must be observed. Before the analysis for 3-5 days, it is necessary to stop taking steroid and hormonal drugs. If this is not possible according to the indications, then the laboratory assistant should be warned about this so that he would make the necessary corrections when deciphering the results. Also, before the analysis, you can not do a blood transfusion or dialysis. 2-3 days before the analysis, you need to stop playing sports or heavy physical labor.

Well, the last condition - all tests for hormones are done on an empty stomach, including erythropoietin. So before donating blood, you can’t eat anything for 7-8 hours, and you can only drink plain water.

Normalization of erythropoietin levels

Having dealt with the question - what is erythropoietin, it becomes clear that the normalization of its level in the blood depends on the treatment of the pathology that caused the imbalance of the hormone. That is, after removal of a cyst from the kidneys, or treatment of a viral disease, the hormone level will soon return to normal.

But to speed up this process, pharmacology has developed several drugs that help to produce erythropoietin faster. Or replacing it, for the duration of therapy, with synthetic analogues. Also, such drugs are prescribed for patients with anemia and chronic kidney disease. It can be "Epoetin", "Erythrostim", "Recormon" or "Vero-epoetin". All drugs are prescribed only by a doctor, after passing all the necessary tests and passing other diagnostic procedures.

All of the listed drugs are prescribed for very specific diseases:

With chronic renal failure.
With a benign tumor of the kidneys or adrenal gland. They are also used during the recovery period of the patient after surgery to remove the tumor.
The drugs are included in the complex of rehabilitation measures after the patient has undergone chemotherapy.
With anemia of various types.
The drugs are used as a preventive measure, before surgery, with possible blood loss.
When feeding a child born with a lack of weight or premature.

Drugs have a lot of side effects, and if the dosage or regimen is incorrect, they can cause health-threatening consequences.

If during the course of taking the drug a person has a severe headache, nausea, dizziness, vomiting, diarrhea and convulsions begin, you should immediately consult a doctor.

There are also alternative drugs. They do not contain the pure hormone erythropoietin, but epoetin beta. Otherwise, this substance is called recombinant glycoprotein. It consists of 150 amino acids, which allows it to create red blood cells from determined cells.

Since the composition of this drug is very similar to the real hormone, it can be administered subcutaneously or intravenously. The speed of action of the drug is not inferior to the natural hormone, which allows you to raise not only the level of red blood cells, but also hemoglobin.

Another plus of epoetin beta is that it contains iron, that is, a building material for the production of red blood cells. Thus, preparations with epoetin beta have found themselves not only in medicine but also in sports. Since the effect of it occurs within 15 after the injection.

Erythropoietin in sports

The effect of erythropoietin on the body is also known by sports trainers. Therefore, preparations containing this hormone are widely used in sports. Although the International Olympic Committee recognized these substances as doping back in 1990. The complexity of monitoring compliance with the IOC requirement lies in the fact that erythropoietin of animal origin is extremely difficult to determine in the body.

But it’s true, this hormone is produced in the body at the time of the greatest load, that is, during the competition. He must be there otherwise the man will die. And its low level is rather an alarming sign, and not the norm. But there have been fatal cases, and with recombinant erythropoietin. Several cyclists died in the late nineties.

One way or another, it is almost impossible to identify an athlete who abuses erythropoietin, so athletes around the world use drugs containing this hormone at their own peril and risk, repeatedly increasing muscle strength, and most importantly, their endurance.