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Erythropoietin and Iron

Lawrence T. Goodnough, MD
Professor of Pathology and Medicine
Stanford University
Stanford, CA, USA



Summary
The US blood supply is the safest it has ever been, due to evolution of a combination of donor education, donor screening, and new laboratory assays. Currently, the most significant risk of mortality from blood transfusion is administrative error resulting in an ABO mismatch between blood unit and transfusion recipient, with hemolysis (one in 60,000) and death (one in 600,000).

Knowledge gained regarding the relationship between erythropoietin, iron, and erythropoiesis suggests that under conditions of maximal stimulation of red blood cell precursors, iron restricted erythropoiesis occurs. The emergence of safer iron preparations makes the administration of intravenous iron a possible solution to the problem of iron restricted erythropoiesis. The value of this approach has been best demonstrated in patients with chronic kidney disease undergoing dialysis. Clinical trials are needed to establish the value of parenteral iron supplementation in other clinical settings employing erythropoietin therapy.

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Blood Management Consultant
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