Treatment of a unique anemia in patients with IDDM with epoetin alfa

OBJECTIVE- To identify and treat a unique form of anemia in patients with long-term IDDM. RESEARCH DESIGN AND METHODS- Patients with IDDM, unexplained symptomatic anemia, and serum creatinine levels of <177 mu mol/l (2.0 mg/dl) were treated with epoetin alfa (Procrit, Ortho Biotech, Raritan, NJ), 50 U/kg three times weekly, subcutaneously, to reach a target hematocrit of 38-40%. Baseline serum erythropoietin titers were measured before drug therapy. RESULTS- Six patients were treated with epoetin alfa. Median age of the group was 74 years, with IDDM being diagnosed for a median of >20 years. All patients had symptoms of anemia with a median hematocrit of 28.9% (range 27-31). Compared with iron deficiency control patients, the group had a limited erythropoietin (EPO) response to the degree of anemia. All patients showed increases in hematocrit, median peak of 40.9%, with median time-to-peak response of 12 weeks. Baseline symptoms of anemia resolved in all patients. No adverse effects were noted during the treatment period. CONCLUSIONS- There is a unique form of anemia in patients with long-term IDDM and clinically normal renal function who respond to low-dose epoetin alfa therapy The rapid response to therapy and depressed baseline erythropoietin titers suggest the anemia is due to a lack of endogenous EPO release.