Erythropoietin

Erythropoietin is a hormone that your kidneys mainly produce. Erythropoietin (ih-rith-roh-POY-uh-tin) helps your body maintain a healthy amount of red blood cells (erythrocytes).

There’s also a synthetic (human-made) form of erythropoietin. Healthcare providers use it to treat anemia that results from chronic kidney disease (CKD). Some athletes improperly use synthetic erythropoietin to help boost performance. It increases the amount of oxygen in your muscles. More oxygen in your muscles gives you more energy. Synthetic EPO is banned in many professional sports and athletic competitions.

Other names for erythropoietin include:

• Erythropoetin
• EPO
• Hematopoietin
• Hemopoietin

What does it do in the body?

Erythropoietin helps make red blood cells. Red blood cells deliver oxygen to the tissues in your body. Oxygen turns into energy, and your tissues release carbon dioxide. Your red blood cells also transport carbon dioxide to your lungs for you to breathe out.

Normally, when specialized cells in your kidneys detect low blood oxygen levels, they increase the production of EPO. EPO then tells the spongy tissue in your bones (bone marrow) to make more red blood cells.

When cells in your kidneys sense there’s enough oxygen in your blood, they tell your kidneys to make less EPO.

Certain conditions can affect how much EPO your kidneys make. They may cause your kidneys to make too much or not enough. This may cause low or high levels of red blood cells.

How do healthcare providers measure erythropoietin?

A healthcare provider can measure your EPO levels with a blood test. Blood tests help your provider figure out what’s affecting how your body releases EPO. Your provider will take a sample of your blood and send it to a lab for analysis. Once the lab finishes its testing, your provider will contact you to discuss your test results and answer any questions.

What is the normal range?

Healthcare providers measure erythropoietin in your blood in milliunits per milliliter (mU/mL). A normal range may be between 4 and 26 mU/mL.

Your EPO test results may vary according to several factors. These may include your:

• Age
• Sex
• Overall health

Your provider will carefully interpret your results. They’ll let you know if they’re in or out of range. Even if your EPO levels are within a normal range, you may still need treatment.

What happens when erythropoietin levels are high?

Inappropriately high levels of erythropoietin can cause high levels of red blood cells. Another name for high red blood cell levels is polycythemia. Polycythemia causes your blood to thicken.

What causes high levels of EPO?

High levels of EPO may result from:

• Long-term exposure to low oxygen levels: Smoking a lot or living in a high-altitude environment can cause low oxygen levels. Elevated EPO from a high-altitude environment is normal. Your body increases the levels appropriately.
• Anemia: Anemia can have many different causes. Any of these causes may result in high EPO levels. Your kidneys sense that you don’t have enough red blood cells, so they release extra EPO. This is a normal and appropriately high level of EPO.
• Tumors: In rare cases, certain tumors can increase your EPO levels. This is an inappropriately high level of EPO.

What causes low levels?

Chronic kidney disease is the most common cause of low EPO levels. Damaged kidneys can’t make as much EPO. CKD and low EPO levels can lead to anemia.

Polycythemia vera (PV) can also lead to low EPO levels. PV is a type of blood cancer. A genetic mutation causes your bone marrow to make too many red blood cells. It causes low EPO levels because your kidneys sense that you have enough red blood cells. As a result, they don’t make as much EPO.

How do you treat low erythropoietin levels?

Treating low levels of EPO requires treating the underlying cause.

The most common treatment is recombinant erythropoietin (erythropoietin-stimulating agents or ESAs). This is a synthetic version of natural EPO. Healthcare providers clone the gene for EPO to cause your body to make more red blood cells. They give it to you as a shot (epoetin alfa injection).

Providers use it to treat anemia that results from chronic kidney disease or kidney failure. They may also give it to people with rare types of cancer.

How can I increase my erythropoietin levels naturally?

If you have CKD or any anemia with low EPO, you may be able to boost your EPO levels with physical activity and dietary iron.

Regular, vigorous physical activity may cause your body to use more oxygen. Your brain then tells your body to create more EPO in response. Bicycling, jogging and swimming are some examples of activities that may cause you to use a lot of oxygen.

Iron is one of the main elements of hemoglobin. Hemoglobin helps carry oxygen to cells in your body. Good sources of dietary iron include:

• Red meat
• Egg yolks
• Liver
• Tofu
• Iron-fortified foods such as cereal, flour and bread