Red blood cell lifespan, erythropoiesis and hemoglobin control
Red blood cell lifespan, erythropoiesis and hemoglobin control
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DOI：
10.1159/000130698
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发表时间：
2008-01-01
期刊：
影响因子：
--
通讯作者：
Levin, Nathan W.
中科院分区：
文献类型：
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作者：
Kruse, Anja;Uehlinger, Dominik E.;Levin, Nathan W.
促红细胞生成素（EPO）和铁缺乏作为肾功能受限或终末期肾病患者贫血的原因已得到很好的解决。随之而来的红细胞（RBC）存活受损在很大程度上被忽视了。尿毒症环境的特性，如炎症、氧化应激增加和尿毒症毒素，似乎是红细胞膜和细胞骨架过早变化的原因。抗原位点的暴露和磷脂酰丝氨酸不对称性的破坏促进红细胞的吞噬作用。虽然个体对 EPO 刺激剂 (ESA) 治疗的反应取决于红细胞的寿命和生产率，但统一的剂量算法无法满足这一需求。一旦获得红细胞生成率和/或寿命的独立估计，预测 ESA 引起的血细胞比容变化的数学模型的临床应用可能会大大改善，从而无需同时估计这两个参数。由于血红素通过血氧合酶途径分解会导致呼出一氧化碳 (CO)，因此使用简单的 CO 呼气测试来计算血红蛋白周转率，从而计算红细胞存活率和寿命。未来的研究必须在肾衰竭患者中验证和实施这种方法。这将为肾脏患者的红细胞动力学带来新的见解。最终，这些发现有望提高我们对 ESA 反应中血红蛋白变异性的理解。版权所有 (C) 2008 S. Karger AG，巴塞尔。
Erythropoietin (EPO) and iron deficiency as causes of anemia in patients with limited renal function or end-stage renal disease are well addressed. The concomitant impairment of red blood cell (RBC) survival has been largely neglected. Properties of the uremic environment like inflammation, increased oxidative stress and uremic toxins seem to be responsible for the premature changes in RBC membrane and cytoskeleton. The exposure of antigenic sites and breakdown of the phosphatidylserine asymmetry promote RBC phagocytosis. While the individual response to treatment with EPO-stimulating agents (ESA) depends on both the RBC's lifespan and the production rate, uniform dosing algorithms do not meet that demand. The clinical use of mathematical models predicting ESA-induced changes in hematocrit might be greatly improved once independent estimates of RBC production rate and/or lifespan become available, thus making the concomitant estimation of both parameters unnecessary. Since heme breakdown by the hemoxygenase pathway results in carbon monoxide (CO) which is exhaled, a simple CO breath test has been used to calculate hemoglobin turnover and therefore RBC survival and lifespan. Future research will have to be done to validate and implement this method in patients with kidney failure. This will result in new insights into RBC kinetics in renal patients. Eventually, these findings are expected to improve our understanding of the hemoglobin variability in response to ESA. Copyright (C) 2008 S. Karger AG, Basel.