EPO is the prime physiological regulator of red blood cell production. EPO is a hormone produced by cells in the kidney that are sensitive to low blood oxygen levels and functions as a cytokine to promote the formation of red blood cells in the bone marrow by binding to the Epo receptor (EpoR) on erythroid progenitors in bone marrow. This binding elicits proliferation, maturation, and differentiation of red blood cells; thereby increase the oxygen-carrying capacity of the blood. Measurement of serum immunoreactive EPO suggests that overproduction of EPO can be an adaptive response to conditions producing tissue hypoxia, such as smoking chronic obstructive pulmonary disease, renal hypoxia or cyanotic heart disease. Elevated levels of EPO can be detected in polycythemia, a disorder in which there is an excess of red blood cells as well as in patients suffering from various neoplastic diseases, such as renal carcinomas and benign renal tumors, liver carcinomas and hepatomas, and cerebellar hemangioblastomas. Conversely, lower than normal levels of EPO are observed in chronic renal failure and in various forms of anemias. As such, the measurement of EPO in the blood is useful in the study of bone marrow disorders and kidney disease.
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