EPO level and Aranesp

[kjanikian]

My mother has intermediate -1 MDS (though Dr thought it had progrssed to int-2 end of May but now says it's back to int-1)
She started on Aranesp and has had 2 injections so far, she was due to have another one and her hgb was 9.1 last week but we also requested EPO and ferritin levels. The EPO was 479 and ferritin was 1000. Her hematologist said d/t her EPO level being elevated she can't get Aranesp and he is not worried about her ferritin level. I thought that an EPO level below 500 had a higher chance or working and it should be continued. (especially b/c her rate of transfusions has decreased). She has also only had 10 units of blood transfused since her dx so the ferritin level concerns me. Is this to be of concern or not? Should more of a workup be done? Thanks you for any information.

[Birgitta-A]

Hi kjanikian,
Did your doctor control EPO before your mother got any treatment (Aranesp or red blood cells)? It is this early EPO result that is interesting.

When she has got Aranesp her EPO of cause increases since Aranesp is EPO.

When she has got red blood cells the EPO can decrease since anemia gives signals to the kindneys to make more EPO that stimulates the bone marrow to make more red blood cells. That means that a higher HGB after transfusion leads to lower EPO.

Many MDS patients have elevated ferritin value before blood transfusions. Did your doctor look at the ferritin value initially?

The ferritin value is always higher directly after a transfusion - I try to control my ferritin 2 days before transfusions so that I can compare all the values.

It is true that many doctors think it is better to start chelating therapy early since it is easier to control the value if the ferritin level hasn't increased too much. They look at liver tests too.

Hope this will help you to help your mother!
Kind regards
Birgitta-A