Tuesday, June 25, 2019

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.




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.

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