Erythropoiesis associated with viral hepatitis in end stage renal disease

We describe an end stage renal disease (ESRD) patient on maintenance hemodialysis who developed a spontaneous increase in erythropoiesis associated with an episode of viral hepatitis. Resolution of the hepatitis was accompanied by a reduction in erythropoiesis with the hemoglobin and hematocrit falling back toward the patient's low baseline levels. Plasma erythropoietin (Ep) titers were measured during the period of active erythropoiesis and were found to be low to low normal. The unusual phenomenon of increased erythropoiesis in ESRD following liver injury has been previously described and is thought to be mediated through increased hepatitic Ep production. The low Ep titers measured in our patient, however, suggest that the liver may be capable of stimulating erythropoiesis by another mechanism.