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)ay

(and Table 3. Erythropoletln cerebellar capIllary hour) of

In

a patIent wIth hemangloma.

sampling

Type

of sample

cystic

E,ythropol.tln, lU/L

ebruary 13 larch 15 16 17 18 21 (0800)b

21 (1200)C

21 (1430)” 21 (1815)#{176} 21 (2230)#{176} 22 (0500) 22 (1 loO)#{176}

a

Phlebotomy

(each

time

Serum Serum Serum Serum Serum Serum

Serum Cyst fluid from tumor

Serum Serum Serum Serum Serum

400

mL)

was

initiated

February

17 23 25 27 22 18 16 7100 11 7.7 8.9 7.6

4.9 18 and continued

irlng March 4 to 17 (10 times total). b Before neurosurgery.

C During operativetumor removal.

“At the During

end of the operation.

postoperative

intensive

care.

)ntlnue ‘he marked tin between ie tumor ecrease iat the oietin. the blood sampling from the concentrations after surgery. of erythropoi- day difference in fluid and erythropoietin, indicated the pronounced that the produced the cyst serum and in concentration tumor removal of circulating after most indicated erythro- contributed tumor

The

possibility

that the

cerebellar

tumor

was a pri-

lary

tumor was

supported

by the

increased

concentra-

(fibroblast to play ions ctor of basic fibroblast growth factor is considered growth a role (Biotrak” Amer- tumor-cyst tubes, 4#{176}C.The which in 2; FGF-2), (12). human; UK) in FGF-2 was ngiogenesis determined FGF ham, basic, Bucks, Amershain in samples ice-chilled International, blood and of uid collected EDTA-containing at rhich lasma the subsequently centrifuged normal but higher were concentration cyst fluid was concentration g1L). Several the (235 was 100-fold i

zmors have ur knowledge, ioblastoma. )und in cases

tis growth ival (8).

been sho FGF-2 High of renal

wn has plasma carcinoma to produce FGF-2, not been reported concentrations (13), and

factor

seems

to be associ

ated

although, in heman-

to

have

been

expression

of

with poor

sur-

Iscussion valuation

of

Polycythemia

In evaluating polycythemia, first objective volume is to is nor- or “abso- (Table 1). decreased the erythrocyt etermine total whether the e or increased, polycythemia, corresponding respectively to “relative” (9, 10, cause 14, 15) of the ite” relative polycythemia, the

lasma

volume

(4)

should

be ascertained.

“Secondary” s inappropriate

eing

a

result

absolute (see of poor

ionary

dysfunction,

below) or high oxygenation polycythemia altitude) or appropriate, (e.g., may cardiac or poor be described the latter or pul- oxygen

delivery abnormal

to

the tissues (e.g., 2,3-diphosphoglycerate

certain

hemoglobinopathies, availability

or

tion) ated

(Table first by

1). These reexamining

forms

of polycythemin

are

the patient’s

cardiopulmonary

func- evalu-

functions,

history

tions blood

tabulated gas analyses.

in

of cyanotic

Table

1,

episodes

and

and,

if

necessary,

the

condi- arterial

of overt one evidence should Primary formation increased and erythremia for secondary In priate the absence polycythemia, appro- consider absolute the possibility polycythe- (5). of polycythemia vera is a result polycythemia of of erythrocytes, mia i.e., eral autonomous vera (with formation (pure of sev- eryth- cells) of blood classes

rocytosis). quently measuring

To has

the

rule to use total

out

“masked”

polycythemia,

iron

replacement

erythrocyte

volume

therapy (16).

one fre- before The pa-

tient attributed normal erythropoietin rum ferritin described to the individuals, results concentration here had increased the and iron rate administration in a pronounced deficiency of red-cell in transferrin decrease of recombinant that could formation. saturation in

be In

se-

(17); portant

therefore,

determination

in evaluating

iron

ing

erythropoietin Erythropoietin

therapy determination

depots (18).

of

agnosis

of polycythemia

vera

(19),

serum ferritin

is im-

in individuals

receiv-

may be used provided

the

in the method

di-

can

differentiate

etin

concentrations

current

literature

between

normal

and

low

erythropoi-

(7, 20-22). on methods

However,

a review

for

erythropoietin

of the deter-

mination may be

(unpublished) considered

indicates clinically useful.

that

only

a few

assays

Erythropoietin

Biosynthesis

and

Regulation

Erythropoietin,

duced

in the renal

oxygen

availability.

protein

(25). The

  • -

    35%

carbohydrate

a 30-kDa

glycoprotein

consisting

cells (166 cortex The that

amino acids) in response

oxygen

senso

r

(23,

24),

to a

decrease

may

be a

produce

eiythropoietin

of is pro- in

heme

have

not been

firmly

established

cells cells

of endothelial

origin

(27).

A “hypoxia-inducible

but (26)

might

be the peritubular

factor or the tubular has

(epithelial)

been

impli-

cated (28,

as 29),

a regulator

and

the

of erythropoietin erythropoietin

gene

gene transcription (30, 31) on chro-

by etin ample mosome oxygen is also of a 7q11-22 human tension produced (32, gene (28).

33) is the whose A small in the adult expression amount liver best-characterized . is of (In

ex-

modulated erythropoi- the fetus,

most

erythropoietin

formation

occurs

in the

liver.)

Like

many etin and charge erythropoietin other shows liver (34).

polypeptide a molecular erythropoietin Hormones formatio

n

hormones, serum charge heterogeneity,

erytbropoi- with renal

seemingly and drugs

differing reported

in mean to increase

are

thyroid

hormones,

andro-

gens,

-adrenergic

agonists,

prostaglandins

(35), and

atrial

natriuretic

factor (36).

The autonomic

nervous

of erythropoietin

(37).

increase

after

stimulation

system

has

been

proposed

formation

may

receptors

(35).

production

as influencing Erythropoietin of adenosine

the

factor

I stim-

through

in-

Growth

hormone

ulate

erythropoiesis

and

insulin-like directly,

as

growth well

as

CLINICAL

CHEMISTRY,

Vol. 40,

No. 11,

1994

2095

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