Treatment of chronic skin ulcers in individuals with anemia of chronic disease using recombinant human erythropoietin (EPO): a review of four cases.

Patients with hemoglobin greater than or equal to 100 g/L may have difficulty healing pressure ulcers because of impaired tissue oxygenation. Decreased hemoglobin is often anemia of chronic disease and may be due to the effects of inflammatory cytokines on erythroid progenitor cells. Recombinant human erythropoietin has been found to reverse anemia of chronic disease and may act as a growth factor in wound healing. To review the effect of 6 weeks of subcutaneous recombinant human erythropoietin 75 IU/kg administered 3 times weekly to resolve refractory anemia of chronic disease and heal Stage IV pressure ulcers, a retrospective chart review was conducted of four spinal cord injured patients (all men, mean age 59 years +/- 19) with Stage IV pressure ulcers and multiple comorbid conditions. The patients received recombinant human erythropoietin either through an inpatient spinal cord rehabilitation unit or an outpatient wound management clinic as part of interdisciplinary care. Mean hemoglobin increased from 88 +/- 7.4 g/L to 110 +/- 3.7 g/L. Mean ulcer surface area decreased from 42.3 cm2 (+/- 40.2) to 37.3 cm2 (+/- 44.3) despite extensive deroofing of one ulcer and subsequent increase in size. Mean ulcer depth decreased from 2.3 cm (+/- 1.2) to 1.2 cm (+/- 1.0). Human recombinant erythropoietin shows promise in resolving the refractory anemia of chronic disease associated with Stage IV pressure ulcers. Further study is suggested.