1. Patient has anemia associated with renal insufficiency or failure

    a. Predialysis patients with HCT <28, and erythropoietin level <200

    b. Patients undergoing renal dialysis

2. Patients with zidovudine induced anemia with erythropoietin level <500 and HCT <30.

3. Patient has symptomatic anemia as seen in

    a. Multiple myeloma with HCT <27 and erythropoietin level < 200.

    b. Rheumatoid arthritis with HCT <32 and erythropoietin level < 500

    c. Malignancy or antineoplastic drug therapy with erythropoietin level <200 mU/ml. and HCT <32.

    d. Myelodysplastic anemia with HCT <30 12 week dose limit without results

    e. Sideroblastic anemia with HCT <30 erythropoietin level <500mU/ml.

4. Prior to elective surgery when large perisurgical blood loss is expected and blood transfusion is unacceptable.

    a. Patient can be categorized under # 1, 2, or 3 above or

    b. Religious beliefs prevent transfusions or

    c. For enhancement of autologous blood donation

5. Pretreatment laboratory studies indicate probable response to therapy.

    a. Transferrin saturation > or = 20%

    b. Serum ferritin > or = 100 ng/ml.

    c. Hematocrit as defined in #2 in non-dialysis patients

    d. Erythropoietin level as defined in criteria # 1, 2, and 3

6. Hypertension is under adequate control.

7. There is no known hypersensitivity to mammalian cell-derived products or to albumin.

Dose:

Starting dose: 50 - 100 units/kg 2-3 times weekly I.V. or SQ.

Adjust dose by HCT at rates or + or - 25 units/kg.

Decrease dose - HCT reaches 30 - 33 % or HCT increases 4 pts in any 2 week period

Increase dose - Less than 5-6 pts increase in HCT after 8 weeks of therapy and still < 30 %.

Withhold dose - HCT > 36%.

Monitor:

Blood Pressure - routinely in renal patients

Iron stores - every 3 months

HCT - every 2 weeks

Outcome:

Improvement noted in progress notes

Hematocrit documented