Alpha thalassemiais more common among Asians and those with Asian ancestry. Treatment ofAlpha thalassemia with Epoetin may increase Hgb slowly, with effective therapyusually requiring very high doses over a long period. While most of the available literaturesuggests that effective Epoetin therapy does not require concomitant vitaminB12 and folate supplementation, the latter is water soluble and dialysatelosses may exceed intake in poorly nourished patients. Therefore, loss ofresponsiveness to Epoetin requires investigation of cofactor adequacy. Specifically, this study suggests that even if folate levels are adequateat the inception of Epoetin therapy, macrocytosis and poor response willdevelop without continuous cofactor replacement.
Iron overload is alsoassociated with macrocytosis.
Reports on the effectiveness of Epoetin treatmentin this setting are few, contain small numbers of patients, and have variableresults. Despite this potential concern,Epoetin is not contraindicated in the treatment of the anemia of patientswith myeloma kidney disease. Low serum albumin is associated with low Hgb among dialysispatients. About one-third of CRF patients have low albumin. While malnutritionis common in this population, any acute or chronic inflammatory conditionmay result in a low serum albumin.