A client receiving epoetin alfa should have the desired effect evidenced by which change?

• A. Increased hematocrit level
• B. Decreased lymphocytes
• C. Increased platelet count
• D. Decreased neutrophils

Answer: (A)

Epoetin alfa stimulates red blood cell production by acting on erythroid progenitor cells in the bone marrow. The main goal of this therapy is to increase the red cell mass, which is most directly evidenced by a rise in hematocrit (and hemoglobin) levels. So, seeing an increased hematocrit indicates the drug is producing the desired effect.

Lymphocytes, neutrophils, and platelets come from other blood cell lineages and are not directly increased by erythropoietin stimulation, so changes in those counts wouldn’t reflect the expected therapeutic response. Keep in mind that iron status and blood pressure should be monitored, as adequate iron is needed for erythropoiesis and high hematocrit can elevate thrombotic risk.