Background/Aims : The characteristics of erythropoietin response in patients suffering with anemia of chronic disease and in the patients with various other anemias are poorly defined. Thus, we evaluated the clinical factors that influence the erythropoietin response. Methods : We enrolled the anemic patients (hemoglobin <13 g/dL for males and <12 g/dL for females) who visited the Hematology-Oncology department of Konkuk University Hospital from Mar 2006 to April 2007. The laboratory tests, including the complete blood count, serum ferritin, serum vitamin B12/folate, the peripheral blood morphology and serum erythropoietin, were done. The erythropoietin response to anemia was assessed by the ratio of the log of the measured erythropoietin to the log of the expected erythropoietin. Results : A total of 161 patients, including 42 iron-deficiency anemia (IDA) patients, were analyzed. 119 non-IDA patients were diagnosed with infection (n=46), chronic renal failure (n=27), cancer (n=20), heart failure (n=12), or with other diseases (n=14). Except for the cancer patients, all the patients with other diseases showed a blunted erythropoietin response in comparison with the IDA patients (p=0.000). Among the non-IDA patients, those patients older than 65 years showed more blunted erythropoietin response than did the younger patients (p=0.01), and the diabetics without renal dysfunction also tended to respond better to erythropoietin than did the non-diabetics (p=0.055). Conclusion : A blunted erythropoietin response was observed in most of the anemic patients in our study. Old age and diabetes may further blunt the erythropoietin response. The feasibility of erythropoietin testing and supplementation treatment in these patients merits further evaluation. (Korean J Med 74:531-536, 2008)

Background/Aims : The characteristics of erythropoietin response in patients suffering with anemia of chronic disease and in the patients with various other anemias are poorly defined. Thus, we evaluated the clinical factors that influence the erythropoietin response. Methods : We enrolled the anemic patients (hemoglobin <13 g/dL for males and <12 g/dL for females) who visited the Hematology-Oncology department of Konkuk University Hospital from Mar 2006 to April 2007. The laboratory tests, including the complete blood count, serum ferritin, serum vitamin B12/folate, the peripheral blood morphology and serum erythropoietin, were done. The erythropoietin response to anemia was assessed by the ratio of the log of the measured erythropoietin to the log of the expected erythropoietin. Results : A total of 161 patients, including 42 iron-deficiency anemia (IDA) patients, were analyzed. 119 non-IDA patients were diagnosed with infection (n=46), chronic renal failure (n=27), cancer (n=20), heart failure (n=12), or with other diseases (n=14). Except for the cancer patients, all the patients with other diseases showed a blunted erythropoietin response in comparison with the IDA patients (p=0.000). Among the non-IDA patients, those patients older than 65 years showed more blunted erythropoietin response than did the younger patients (p=0.01), and the diabetics without renal dysfunction also tended to respond better to erythropoietin than did the non-diabetics (p=0.055). Conclusion : A blunted erythropoietin response was observed in most of the anemic patients in our study. Old age and diabetes may further blunt the erythropoietin response. The feasibility of erythropoietin testing and supplementation treatment in these patients merits further evaluation. (Korean J Med 74:531-536, 2008)

목적 : 만성질환빈혈은 입원환자에서 가장 흔히 발생하지만 기저 질환의 범위나 병태생리가 명확히 정의되어 있지 않다. 저자는 이러한 빈혈을 포함한 다양한 빈혈에서 적혈구생성인자(EPO)의 분비의 특성을 알아보고 기저 질환별 차이점과 분비에 영향을 주는 임상적 인자를 알아보고자 하였다. 방법 : 2006년 3월 1일부터 2007년 4월 30일까지 건국대학교병원 종양혈액내과에서 빈혈(남: 혈색소<13 g/dL, 여: 혈색소<12 g/dL)로 진단된 환자를 대상으로 일반적 검사와 함께 혈중 적혈구생성인자(EPO) 값을 구하였다. 그리고 이들 환자에서 혈색소에 따른 EPO 분비의 적절성을 평가하여 질환별로 비교하였다. 결과 : 총 161명의 환자가 연구에 포함되었다. 철결핍빈혈군(42명)에 비해 만성질환빈혈군(119명)에서 EPO의 분비가 유의하게 감소되어 있었다(p=0.000). 악성 종양군(20명)을 제외한 감염군(46명), 신부전군(27명) 외에도 심부전군(12명), 기타 질환군(14명) 모두에서 유의하게 EPO 감소가 관찰되었다. 연령별로는 65세 이상의 환자군이 65세 미만 환자군에 비해 유의하게 EPO의 분비가 저하되어 있었고(p=0.01), 신부전이 동반된 경우를 제외한 당뇨 환자군에서도 비당뇨 환자군에 비해 EPO의 분비가 저하되는 경향을 보였다(p=0.055). 결론 : 만성질환 동반 빈혈을 포함한 여러 가지 빈혈은 EPO 분비가 감소되어 있었고, 또한 고령이나 당뇨 등이 EPO 분비를 감소시키는 경향을 보였다. 이러한 빈혈 환자에서의 진단적 EPO 측정 및 치료목적 투여에 대한 추가적인 연구가 앞으로 필요한 것으로 생각된다.

Erythropoietin; Anemia; Old age; Diabetes mellitus