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Erythropoietin (EPO): what it is, how it works, and who it is prescribed for

Erythropoietin (EPO) is a glycoprotein hormone that plays a key role in regulating blood formation. It controls the formation of erythrocytes — red blood cells that transport oxygen to all organs and tissues. Most erythropoietin is produced by the kidneys, and a small amount by the liver.

Synthetic analogues of erythropoietin are used in medicine to help treat anemia of various origins. Due to their high effectiveness, these drugs have become an important part of therapy for severe diseases accompanied by a decrease in hemoglobin levels.

1. The history of the discovery and development of EPO drugs

Erythropoietin was discovered as a hormone in the 1950s, when scientists noticed that patients with anemia due to renal failure had reduced red blood cell production. Early research established that there was a factor in the blood that stimulated the bone marrow—this factor turned out to be erythropoietin.

In 1977, researchers isolated this hormone for the first time and began to study its structure. By the 1980s, scientists had developed recombinant erythropoietin (rEPO), which became the first synthetic analogue of the natural hormone.

Since 1989, recombinant EPO has been used in clinical practice to treat anemia in chronic renal failure. Later, more modern forms appeared — epoetin beta, darbepoetin alfa, and CERA, which differ in duration of action and ease of administration.

Today, EPO drugs are the standard treatment for anemia in patients with renal failure, cancer, and other conditions requiring stimulation of blood formation. Their development was an important milestone in the development of biotechnological medicine and demonstrates the success of recombinant proteins in the treatment of chronic diseases.

2. How erythropoietin works

Erythropoietin triggers the process of erythropoiesis—the formation of red blood cells in the bone marrow.

When the body experiences oxygen deprivation (hypoxia), the kidneys release more EPO. This is a natural response to a decrease in oxygen in the blood. As a result, the bone marrow produces red blood cells more actively, improving oxygen saturation in the tissues.

The mechanism can be described as follows:

1. Decreased oxygen —→ increased EPO production
2. EPO stimulates the bone marrow
3. Accelerated red blood cell production
4. Increased hemoglobin and improved oxygen transport

This biological mechanism is the basis for the medical use of the drug.

3. Medical indications for prescribing erythropoietin

Synthetic forms of erythropoietin are used strictly according to indications. They are prescribed in the following cases:

✔ Chronic renal failure

The kidneys are the main organ that produces EPO, so when they are damaged, there is not enough of the hormone.

✔ Anemia in cancer patients

This often occurs as a result of chemotherapy or disease progression.

✔ Anemia in HIV therapy

Some drugs can lower red blood cell counts.

✔ Congenital blood disorders

When red blood cell production is insufficient.

✔ Preparation for surgery

Sometimes used when there is a risk of significant blood loss (as indicated).

Erythropoietin is always prescribed after a comprehensive blood test and assessment of the causes of anemia.

4. Forms of erythropoietin

There are several varieties of the drug:

• Epoetin alfa
• Epoetin beta
• Darbepoetin alfa (longer acting)
• Methoxy polyethylene glycol-erythropoietin beta (CERA)

Each form differs in terms of duration of action, absorption rate, and specific indications, but all require medical supervision.

5. How EPO therapy is prescribed and monitored

Before starting treatment, the doctor conducts tests to check:

• hemoglobin levels,
• hematocrit,
• ferritin and iron,
• kidney function,
• bone marrow condition.

After prescribing the drug, it is administered subcutaneously or, less commonly, intravenously.

The patient must undergo regular tests to avoid excessive red blood cell growth.

Monitoring is important because:

• too high a hematocrit can lead to thrombosis,
• incorrect dosage increases the load on the heart,
• excess EPO can cause complications in people with hypertension or cardiovascular disease.

6. Possible side effects of erythropoietin

Like any potent drug, erythropoietin can have side effects:

• increased blood pressure,
• headaches,
• bone or joint pain,
• thromboembolic complications,
• accelerated blood thickening,
• allergic reactions.

Therefore, the drug is prescribed only when strictly indicated.

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8. Conclusion

Erythropoietin is a vital hormone and an effective drug that helps patients with severe forms of anemia. It saves lives, improves the quality of therapy, and is an important part of modern medicine.

However, erythropoietin is not a self-medication tool or an “endurance doping” agent. Its use requires professional supervision, accurate diagnosis, and strict adherence to medical recommendations.