Serum erythropoietin level in anemic and non-anemic patients with chronic leukemia

Abstract

Background: Anemia is a common issue in chronic leukemia, which results in a worse outcome and shorter survival. Inadequate production of erythropoietin (EPO) as compared to the severity of anemia may play a major role in ACD for patients with hematological malignancies. Clarifying the role of EPO may provide a better understanding of its pathogenesis, and proper management of patients. Objectives: To determine serum EPO levels and look for any potential link between EPO and the cause of anemia in anemic patients with chronic leukemia in a sample of Iraqi patients in the middle euphrates region. Materials and Methods: This is a case control study included 38 patients (19 chronic myeloid leukemia [CML], 19 chronic lymphocytic leukemia [CLL]) who were attending the outpatient clinic of hematology in Baghdad Teaching Hospital, Marjan Teaching Hospital from September 2022 to March 2023, together with 30 adult participants without disease as a control group. All patients involved were diagnosed as having a disease based on a specialist’s physical examination, morphological evaluation of peripheral blood films and bone marrow, and flow cytometric immune-phenotypic profile. Blood samples were collected from each subject, and the following investigations were done: CBC, RFT, blood film examination, and ELISA assay for serum EPO. Results: The mean age of CML patients was (50.1 ± 12.85) range from 24 to 72, CLL patients (58.2 ± 10.4) range from 38 to 75. The majority of patients were men (N = 23, 60.5%). The participants in the patient group were subdivided into 18 (47.4%) patients with anemia and 20 (52.6%) patients without anemia. The mean differences of EPO concentration (U/L) between study groups demonstrated significant higher level among patient group (49.53 ± 56.82) than control group (12.73 ± 4.72) with P value < 0.0001. The level of serum EPO in anemic patients (89.28 ± 61.95) has been found to be higher than non-anemic patients (13.82 ± 4.43) and it was statistically significant (P < 0.0001). Endogenous EPO production was found to be defective in 10% of CML patients, 50% of CLL patients were judged by a value for the ratio of observed-to-predicted serum EPO levels (observed/predicted ratio) of ≤0.9. Conclusion: These findings indicate that anemia associated with hematologic malignancy may result from an inappropriately low EPO response. EPO treatment should benefit in this group of patients.

Keywords

• anemia
• chronic leukemia
• erythropoietin
• middle euphrates