INTRAVENOUS POLYCLONAL IMMUNOGLOBULINS STIMULATE ERYTHROPOIESIS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Introduction and Aims: The action of immunoglobulins on the erythroblasts' erythroid receptor involved in the modulation of response to erythropoietin, in normal and pathological conditions, has shown a new system of positive regulation of erythropoiesis. Using these data as a starting point, we wanted to study the response of bone marrow to intravenous bolus administration of high doses of polyclonal immunoglobulins in patients with chronic kidney disease (CKD) stage III and IV. Methods: Ten patients affected by CKD and/or by autoimmune diseases have been treated with infusion of polyclonal immunoglobulins (0.200 g/kg of body weight), and serum erythropoietin, CD34 as an early marker of erythropoiesis, Hb and reticulocytes were assessed (at the time intervals T0 and T1). The following day they have undergone the same infusion, blood sampling for the same assays, and also subcutaneous administration of erythropoietin alpha 4000 IU (at the times T2 and T3). Results: The administration of immunoglobulins has pointed out a statistically significant increase in the erythropoietin and CD34 levels. At the end of the two boli, erythropoietin values increased up to 85%.Serum erythropoietin significantly increased after administration of polyclonal immunoglobulins (Ig) in all CKD patients.After the administration of polyclonal immunoglobulins, the percentage of CD34 increased in a statistically significant manner in our patients with CKD, as to show a prompt response to erythropoiesis. Conclusions: Our study demonstrates that the infusion of polyclonal immunoglobulins increases the levels of serum erythropoietin and CD34 right from its first administration. The treatment with polyclonal immunoglobulins and erythropoietin alpha increases CD34 production in a statistically significant manner. These data seem to suggest a new therapy for anaemia in patients with CKD. In conclusion, immunoglobulins behave as "enhancers of erythropoiesis", acting in cooperation with erythropoietin in promoting erythropoiesis.