Epoetin alfa is used for the treatment of anemia, with individualized dosing based on etiology, and at the lowest effective dose to reduce transfusion requirements.

I. Indications

1. Anemia in chronic kidney disease (CKD): Indicated for both dialysis and non-dialysis patients, with the goal of reducing transfusions.

2. Zidovudine-related anemia (HIV infection): Used when zidovudine dose is ≤4200 mg/week and endogenous erythropoietin level is ≤500 mUnits/mL.

3. Chemotherapy-induced anemia (cancer): For non-myeloid malignancies, caused by myelosuppressive chemotherapy, with at least 2 more months of planned chemotherapy.

4. Preoperative autologous blood donation: For patients with preoperative hemoglobin >10 to ≤13 g/dL and anticipated major blood loss, to reduce allogeneic transfusion.

II. Dosage and Administration

1. Chronic kidney disease (adults): Starting dose 50-100 units/kg, three times weekly; intravenous administration is recommended for dialysis patients.

2. Chronic kidney disease (children ≥1 month): Starting dose 50 units/kg, three times weekly.

3. Chemotherapy-induced anemia (adults): 150 units/kg (three times weekly) or 40,000 units (once weekly), subcutaneous injection.

4. Chemotherapy-induced anemia (children 5-18 years): Starting dose 600 units/kg, intravenous once weekly.

5. Perioperative use: Regimen A: 300 units/kg daily (given on days 10, 9, 8, 7, 6, 5, 4, 3, 2, 1 before surgery, on the day of surgery, and on days 1-4 after surgery); Regimen B: 600 units/kg (given on days 21, 14, and 7 before surgery, and on the day of surgery).

6. Zidovudine-related anemia (adults): Starting dose 100 units/kg, three times weekly.

III. Dose Adjustment Principles

1. Target: Use the lowest effective dose, and maintain hemoglobin not exceeding 110 g/L.

2. Dose reduction: If hemoglobin rises by >10 g/L within 2 weeks, reduce the dose by at least 25%.

3. Dose increase: If hemoglobin increase is<10 g/L after 4 weeks of therapy, may increase by 25%; the interval between dose increases should be at least 4 weeks.

4. Discontinuation: In chemotherapy patients, discontinue if no response after 8 weeks or if transfusion is still required; in zidovudine-related anemia, discontinue if no response after 8 weeks at 300 units/kg; in any patient, discontinue if no satisfactory response after 12 weeks of titration.

IV. Pretreatment Preparation

1. Exclude and correct other causes of anemia, such as iron deficiency, vitamin deficiency, infection, bleeding, etc.

2. Maintain iron stores during therapy (supplement iron when ferritin<100 µg/L or transferrin saturation <20%).