Erythropoietin (EPO, The EPO Test)

  • Medical Author:
    Siamak N. Nabili, MD, MPH

    Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Erythropoietin (EPO) facts

  • Erythropoietin (EPO) is a hormone produced by the kidney.
  • Erythropoietin promotes the formation of red blood cells by the bone marrow.
  • The erythropoietin hormone level can be detected and measured in the blood (the EPO test).
  • Measurement of the blood erythropoietin level can be used to detect certain medical conditions.
  • Erythropoietin can be synthesized and used as a treatment of some forms of anemia.
  • Erythropoietin has been misused as a performance-enhancing drug by some athletes.

What is erythropoietin (EPO)?

Erythropoietin (EPO) is a hormone produced by the kidney that promotes the formation of red blood cells by the bone marrow.

The kidney cells that make erythropoietin are sensitive to low oxygen levels in the blood that travels through the kidney. These cells make and release erythropoietin when the oxygen level is too low. A low oxygen level may indicate a diminished number of red blood cells (anemia), or hemoglobin molecules that carry oxygen through the body.

Chemically, what is erythropoietin (EPO)?

Erythropoietin is a protein with an attached sugar (a glycoprotein). It is one of a number of similar glycoproteins that serve as stimulants for the growth of specific types of blood cells in the bone marrow.

What exactly does erythropoietin (EPO) do?

Erythropoietin stimulates the bone marrow to produce more red blood cells. The resulting rise in red cells increases the oxygen-carrying capacity of the blood.

As the prime regulator of red cell production, erythropoietin's major functions are to:

  1. Promote the development of red blood cells.
  2. Initiate the synthesis of hemoglobin, the molecule within red blood cells that transports oxygen.
the heart and blood flow

Erythropeoietin (EPO) Blood Doping

Lance cheated. Deep in our hearts we knew it, but until the words came out of his mouth, there was a glimmer of hope that he still could be our hero. Now he has fallen, admitting that he blood doped, used steroids and erythropoietin (EPO), and exhibited disdain to those around him, both friend and foe. The problem, however, is that sports are always filled with cheating, and the public accepts some acts of dishonesty as part of the game. The distinction between what is ethically acceptable and what is not continues to be a blurred line.

Muscle cells are factories that take the raw materials, oxygen and glucose, and turn them into energy. Training increases the ability of the body to deliver oxygen to the cells and increases muscle size. More efficiency and more power yield better athletic performance. Increasing the number of red blood cells in the body increases the ability to deliver oxygen to tissues and that's where blood doping and EPO come in.

Is the kidney the sole source of erythropoietin (EPO)?

No. Erythropoietin is produced to a lesser extent by the liver. Only about 10% of erythropoietin is produced in the liver. The erythropoietin gene has been found on human chromosome 7 (in band 7q21). Different DNA sequences flanking the erythropoietin gene act to control liver versus kidney production of erythropoietin.

Why is an erythropoietin (EPO) test performed?

The erythropoietin hormone can be detected and measured in the blood. An abnormal level of erythropoietin in the blood can indicate bone marrow disorders, (such as polycythemia, or increased red blood cell production) kidney disease, or erythropoietin abuse. Testing erythropoietin blood levels is of value if:

  • Too little erythropoietin might be responsible for too few red blood cells (anemia), especially anemia related to kidney disease.
  • Too much erythropoietin might be causing too many red blood cells (polycythemia).
  • Too much erythropoietin might be evidence for a kidney tumor.
  • Too much erythropoietin in an athlete may suggest erythropoietin abuse.

How is the erythropoietin (EPO) test performed?

The patient is usually asked to fast for 8-10 hours (overnight) and sometimes to lie quietly and relax for 20 or 30 minutes before the test. The test requires a routine sample of blood, which is sent to the laboratory for analysis.

What are normal erythropoietin (EPO) levels?

Normal levels of erythropoietin range from 4 up to 24 mU/ml (milliunits per milliliter).

What does an abnormal erythropoietin (EPO) level indicate?

Abnormal erythropoietin levels suggest possible disease of the bone marrow or kidneys. Another possibility is abuse by an athlete to increase the red cell count for better athletic performance. The correct interpretation of an abnormal erythropoietin level depends on the particular clinical situation. Sometimes, the erythropoetin level may be inappropriately normal when it should be elevated (such as when there is an anemia), indicating a problem with the kidneys.

Can a person without a medical disease or condition have a high erythropoietin (EPO) level?

Yes. For example, erythropoietin has been misused as a performance-enhancing drug in athletes such as cyclists (in the Tour de France), long-distance runners, speed skaters, and Nordic (cross-country) skiers. When misused in such situations, erythropoietin is thought to be especially dangerous (perhaps becausedehydration due to vigorous exercise can further increase the thickness (viscosity) of the blood, raising the risk for blood clots, heart attacks, and strokes. Erythropoietin has been banned by the Tour de France, the Olympics, and other sports organizations.

Is erythropoietin (EPO) available as a prescribed medication?

Yes. Using recombinant DNA technology, erythropoietin has been synthetically produced for use as a treatment for persons with certain types of anemia. Erythropoietin can be used to correct anemia by stimulating red blood cell production in the bone marrow in these conditions. The medication is known as epoetin alfa (Epogen, Procrit) or as darbepoietin alfa (Arnesp). It can be given as an injection intravenously (into a vein) or subcutaneously (under the skin).

What are the clinical uses of erythropoietin (EPO)?

Erythropoietin is used in many clinical settings. The most common use is in people with anemia (low blood count) related to kidney dysfunction. When the kidneys are not properly functioning, they produce less than normal amounts of erythropoietin, which can lead to low red blood cell production, or anemia. Therefore, by replacing the erythropoietin with an injection of synthetic erythropoietin, anemia related to kidney disease may be treated. Currently, Epogen or Procrit is a standard part of therapy in patients with kidney disease who require dialysis to both treat and prevent anemia.

Other uses of erythropoietin may include treatment of anemia related to the medication AZT (used to treat AIDS), anemia caused by chemotherapy, anemia caused by dysfunctional bone marrow (where the blood cells are made), and anemia associated with cancer.

Medically reviewed by Michael Wolff, MD; American Board of Urology

REFERENCE:

"Erythropoietin for the anemia of chronic kidney disease among predialysis and peritoneal dialysis patients." UptoDate. Updated Jan 15, 2016

Last Editorial Review: 9/1/2016

Reviewed on 9/1/2016
References
Medically reviewed by Michael Wolff, MD; American Board of Urology

REFERENCE:

"Erythropoietin for the anemia of chronic kidney disease among predialysis and peritoneal dialysis patients." UptoDate. Updated Jan 15, 2016

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