ACE-I and ARBs and red cells

Q: Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ACE-I and ARBs) are prone to cause? (select one) 

 A) Anemia 
B) Erythrocytosis


Answer: A

ACE-I and ARBs suppress the production of erythropoietin. The objective of this question is to bring to attention the benefit of this side effect of  ACE-I and ARBs in at least two situations.

Suppression of erythropoietin by these drugs occur due to an accumulation of N-acetyl-seryl-aspartyl-lysyl-proline which inhibits stem cell multiplication. This makes these drug useful in post-transplant erythrocytosis.

Also, ACE-I and ARBs have shown their utility in polycythemia associated with high altitudes.

#pharmacology
#hematology
#transplantation


References:

1. Yildiz A, Cine N, Akkaya V, et al. Comparison of the effects of enalapril and losartan on posttransplantation erythrocytosis in renal transplant recipients: prospective randomized study. Transplantation 2001; 72:542. 

2. Plata R, Cornejo A, Arratia C, et al. Angiotensin-converting-enzyme inhibition therapy in altitude polycythaemia: a prospective randomised trial. Lancet 2002; 359:663.