Snapshot A 50-year-old man with a history of chronic kidney disease presents to the emergency room for fatigue. He reports he has felt short of breath and fatigued for the past few months. Physical exam shows a man with significant pallor. On laboratory examination, his hemoglobin is found to be 8 g/dL with decreased reticulocyte count. He is given epoeitin alfa with a target hemoglobin of 11 g/dL. introduction Drugs epoetin alpha recombinant human erythropoietin erythropoietin is physiologically released by the kidney in response to hypoxia Mechanism of action stimulates red blood cell production by the bone marrow Clinical use anemia of renal failure bone marrow suppression chemotherapy-induced anemia drug-induced anemia Adverse effects fever nausea and vomiting rash pruritus increased hematocrit leading to thrombosis hypertension