The Regulation of Erythropoiesis in Protein‐Energy‐Malnutrition

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Abstract
The erythropoietin (ESF) content of plasma and urine was studied in children with protein-energy-malnutrition (PEM) living in the Kivu province [Norway] at an altitude of 1467-2000 m. On admission, packed cell volume (PCV) was moderately reduced; after 2 mo. of refeeding PCV had increased but was still lower than in the controls. Plasma ESF was increased on admission and in patients refed for 2 mo. The expected positive correlation between serum and urine ESF levels was found after refeeding but not on admission; the last finding could not be explained by the presence of erythropoiesis inhibiting factor(s) in the urine. In spite of the normal 2,3-DPG [2,3-diphosphoglycerate] and P50 previously described in PEM in Kivu, the anemia associated with this disease is not merely an adaptation to lowered oxygen consumption and there must be some disturbances in the responsiveness of bone marrow to ESF. The high ESF values observed after 2 mo. of refeeding confirm that the restoration of the red cell volume proceeds slowly.