Is there a correlation between raised erythropoietin and thrombotic events in sickle-cell anaemia?

• Published in: The Lancet (British edition) Vol. 352; no. 9127; pp. 566 - 567
• Main Authors: Dale, George L, Alberio, Lorenzo
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 15.08.1998; Lancet; Elsevier Limited
• Subjects: Adult; Anemia, Sickle Cell - blood; Anemia, Sickle Cell - complications; Anemia, Sickle Cell - drug therapy; Anemias. Hemoglobinopathies; Animals; Biological and medical sciences; Case-Control Studies; Cerebrovascular Disorders - etiology; Child; Children & youth; Diseases of red blood cells; Erythropoietin - administration & dosage; Erythropoietin - adverse effects; Erythropoietin - blood; Erythropoietin - physiology; Erythropoietin - therapeutic use; Hematologic and hematopoietic diseases; Humans; Medical research; Medical sciences; Platelet Activation - physiology; Platelet Aggregation - physiology; Recombinant Proteins; Sickle cell anemia; Stroke; Thromboembolism; Thrombosis - etiology; Human; Hemoglobinopathy; Sickle cell anemia; Erythropoietin; Pathophysiology; Cardiovascular disease; Hemopathy; Experimental study; Thrombosis; Genetic disease; Vascular disease; Hemolytic anemia; Animal; Risk factor; Child
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(97)11506-9

Children with sickle-cell anaemia are predisposed to thrombotic strokes, the aetiology of which is unclear. We propose that erythropoietin, produced in response to chronic anaemia, is responsible for changes in platelet reactivity with a resulting increase in thromboses. This hypothesis is based on reports of enhanced aggregability of erythropoietin-driven platelets and an increased rate of thrombosis in patients receiving large doses of recombinant erythropoietin. Experiments in animals have shown that erythropoietin stimulates synthesis of platelets, that erythropoietin-driven platelets are hyper-reactive compared with age-matched control platelets, and that erythropoietin is pro-thrombotic. These data suggest that erythropoietin-dependent changes in platelet reactivity may potentiate thrombosis in sickle-cell anaemia, particularly in children who, compared with adults, have markedly higher erythropoietin concentrations and incidence of strokes.