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The regulation of erythropoiesis in protein-energy-malnutrition
Insights
Children with protein-energy malnutrition (PEM) have elevated erythropoietin (ESF) levels. Refeeding improves packed cell volume but anemia persists, indicating bone marrow responsiveness issues to ESF.
Area of Science:
- Pediatric Hematology
- Nutritional Science
- Environmental Physiology
Background:
- Protein-energy malnutrition (PEM) is prevalent in high-altitude regions.
- Anemia is a common complication of PEM, particularly in children.
- Erythropoietin (ESF) plays a crucial role in red blood cell production.
Purpose of the Study:
- To investigate erythropoietin (ESF) levels in plasma and urine of children with PEM.
- To assess the relationship between ESF levels and packed cell volume (PCV) during refeeding.
- To explore potential mechanisms underlying anemia in PEM at high altitude.
Main Methods:
- Measurement of plasma and urine erythropoietin (ESF) levels.
- Assessment of packed cell volume (PCV) in children with PEM.
- Comparison of ESF and PCV levels before and after a 2-month refeeding period.
- Analysis of correlation between serum and urine ESF levels.
Main Results:
- Children with PEM exhibited reduced PCV on admission, which improved but remained lower than controls after refeeding.
- Plasma ESF levels were elevated on admission and persisted after 2 months of refeeding.
- A positive correlation between serum and urine ESF was observed post-refeeding, but not on admission.
- Normal 2,3-DPG and P50 levels suggest anemia is not solely due to adaptation to low oxygen consumption.
Conclusions:
- Anemia in PEM at high altitude is likely due to impaired bone marrow responsiveness to ESF, not just adaptation.
- Elevated ESF levels post-refeeding indicate a slow restoration of red blood cell volume.
- Further research is needed to elucidate the exact mechanisms of ESF resistance in PEM.
Abstract:
The erythropoietin (ESF) content of plasma and urine has been studied in children with protein-energy-malnutrition (PEM) living in the Kivu province at an altitude of 1467--2000 m. On admission, packed cell volume (PCV) was moderately reduced; after 2 months of refeeding PCV had increased but was still lower than in the controls. Plasma ESF was increased on admission and in patients refed for 2 months. The expected positive correlation between serum and urine ESF levels was found after refeeding but not on admission; the last finding could not be explained by the presence of erythropoiesis inhibiting factor(s) in the urine. In spite of the normal 2,3-DPG and P50 previously described in PEM in Kivu, the anaemia associated with this disease is not merely an adaptation to lowered oxygen consumption and there must be some disturbances in the responsiveness of bone marrow to ESF. The high ESF values observed after 2 months of refeeding confirm that the restoration of the red cell volume proceeds slowly.