Snapshot A 60-year-old man with a history of human immunodeficiency virus (HIV) presents to his infectious disease doctor for fatigue. He has been on anti-retroviral therapy, including zidovudine. His lab monitoring has shown progressive decrease in his hemoglobin, requiring a blood transfusion once. As his HIV is stable, he does not wish to change his current treatment regimen. He was told there is a medication that would stimulate his bone marrow to produce more red blood cells. Overview 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 via activation of receptors on erythroid progenitor cells 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