Haemoglobin--is more better?

Recombinant human erythropoietin (r-HuEPO) treatment reduces cardiac output and increases left ventricular mass: beneficial effects that might be expected to be maximized at near-normal haemoglobin values. Quality of life in dialysis patients treated with r-HuEPO has been shown to be related to haemoglobin, up to a haematocrit of 35%. The potential benefits of increasing the target haemoglobin must, however, be seen in the context of the haemodynamic changes that occur during r-HuEPO treatment, in particular, increased peripheral resistance (leading to hypertension), and possible adverse effects on the coagulation system and microcirculation. Pending further trials with a target haemoglobin of 14 g/dl or a haematocrit of 40%, a target haematocrit of 34-37% seems reasonable; it might also be appropriate to adjust the target haematocrit according to the individual's symptoms and lifestyle.