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Erythropoietin (EPO) is a glycoprotein hormone produced primarily by the kidney in response to
hypoxia and is the key regulator of red blood cell (RBC) production. EPO is involved in all phases
of erythroid development, and has its principal effect at the level of erythroid precursors. After
EPO binds to its cell surface receptor, it activates signal transduction pathways that interfere with
apoptosis and stimulates erythoid cell proliferation.
Erythropoietin stimulates erythropoiesis in anaemic patients with chronic renal failure in whom the
endogenous production of erythropoietin is impaired. Because of the length of time required for
erythropoiesis – several days for erythroid progenitors to mature and be released into the
circulation – a clinically significant increase in haemoglobin is usually not observed in less than
two weeks and may require up to ten weeks in some patients.
Erythropoiesis-stimulating agents ESAs are growth factors that primarily stimulate red cell
production. Erythropoietin receptors may be expressed on the surface of a variety of tumour
cells (see PRECAUTIONS – Use in Cancer Patients)