Blood Health

Erythropoietin (EPO), Serum

Optimal Result: 2.6 - 18.5 mIU/ml.

Erythropoietin (EPO) is a hormone produced by the kidney that promotes the formation of red blood cells by the bone marrow.

The kidney cells that make erythropoietin are sensitive to low oxygen levels in the blood that travels through the kidney. These cells make and release erythropoietin when the oxygen level is too low. A low oxygen level may indicate a diminished number of red blood cells (anemia), or hemoglobin molecules that carry oxygen through the body.


- An aid in distinguishing between primary and secondary polycythemia

- Differentiating between appropriate secondary polycythemia (eg, high-altitude living, pulmonary disease, tobacco use) and inappropriate secondary polycythemia (eg, tumors)


Erythropoietin (EPO), a large glycoprotein hormone secreted by the kidney, regulates red blood cell (RBC) production. Normally, EPO levels vary inversely with hematocrit. Hypoxia stimulates EPO release, which, in turn, stimulates bone marrow erythrocyte production. High blood levels of RBC, hemoglobin, hematocrit, or oxygen suppress the release of EPO.

Primary polycythemia (polycythemia vera) is a neoplastic (clonal) blood disorder characterized by autonomous production of hematopoietic cells. Increased RBCs result in compensatory suppression of EPO levels. Findings consistent with polycythemia vera include hemoglobin greater than 18.5 g/dL, persistent leukocytosis, persistent thrombocytosis, unusual thrombosis, splenomegaly, and erythromelalgia (dysesthesia and erythema involving the distal extremities).

Secondary polycythemias may either be due to an appropriate or an inappropriate increase in red cell mass. Appropriate secondary polycythemias (eg, high-altitude living and pulmonary disease) are characterized by hypoxia and a compensatory increase in red cell mass. EPO production is increased in an attempt to increase the delivery of oxygen by increasing the number of oxygen-carrying RBCs. Some tumors secrete EPO or EPO-like proteins; examples include tumors of the kidney, liver, lung, and brain. Such increases result in inappropriate secondary polycythemias.

Abnormal EPO levels also may be seen in renal failure. The majority of EPO production is in the kidneys. Therefore, chronic kidney failure may result in decreased EPO production and, subsequently, anemia. In addition to the kidneys, the liver also produces a small amount of EPO. Thus, patients who are anephric have a residual amount of EPO produced by the liver.

What does it mean if your Erythropoietin (EPO), Serum result is too low?

Low levels of erythropoietin occur when someone is suffering from chronic kidney diseases. Low red blood cell counts cause anemia; symptoms include fatigue, shortness of breath, increased heart rate, and dizziness.

What does it mean if your Erythropoietin (EPO), Serum result is too high?

- Too much erythropoietin might be causing too many red blood cells (=polycythemia).
- Too much erythropoietin might be evidence for a kidney tumor.
- Too much erythropoietin in an athlete may suggest erythropoietin abuse.


Individuals can suffer from having too much erythropoietin in the blood. High levels of the hormone often occur when the body experiences chronic low levels of blood oxygen or if tumors produce the hormone. When this occurs, the patient will develop a high red blood cell count, which is called polycythaemia. This can produce few symptoms, but sometimes will produce itching, dizziness, joint pain, and fatigue.

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