Epoetin Alfa/Beta/Zeta (ESA)

How it works

They are recombinant forms of human erythropoietin that bind the erythropoietin receptor on marrow erythroid progenitors, stimulating their proliferation and differentiation into mature red cells.

Prescribing in practice

• Raising haemoglobin too high or too quickly increases the risk of thromboembolic events, hypertension and, in cancer, possible reduced survival, so the lowest dose to avoid transfusion should be used and a target haemoglobin range observed.
• Iron status must be optimised, as functional iron deficiency is a common cause of inadequate response.
• Blood pressure must be controlled and pure red cell aplasia, though rare, should be considered if response is suddenly lost.

Monitoring

Monitor haemoglobin regularly to keep it within the recommended range, together with blood pressure, iron indices and serum potassium.

Counselling the patient

• Attend regular blood tests so the dose can be adjusted to keep your haemoglobin in a safe range.
• Report severe headache, visual disturbance or signs of a clot such as leg swelling or breathlessness.
• Tell the team if your blood pressure readings are high or you feel unwell after injections.

Evidence & guidelines

ESA use in renal and chemotherapy-induced anaemia is supported by NICE guidance, with target-haemoglobin limits reflecting trials linking higher targets to increased cardiovascular and thrombotic risk.