Erythropoietin is a hormone originally manufactured and secreted by the liver in the embryonic stage of humans. Shortly after birth, the manufacture and secretion of erythropoietin migrates to the kidneys. Erythropoietin is what tells the bone marrow, specifically B12, to convert iron into hemoglobin.
In keeping with the analogy of iron being bricks, B12 being stonemason and hemoglobin being a brick wall, erythropoietin is the general contractor the guy that gives all the orders.
In the early 90s, synthetic erythropoietin was developed. It was originally used in cancer patients whose chemotherapy caused anemia (it is commonly used cancer of the ovary, testicular cancer and of cancer of the prostate}. It was erythropoietin used in Lance Armstrong’s testicular cancer treatment that got him expelled from the professional bicycle racing circuit. Erythropoietin is a banned substance in endurance sports because it can be used to elevate the athlete’s hemoglobin to extreme levels, thus increasing their oxygen storage potential.
In the late 90s synthetic erythropoietin started to be used in the preoperative population, specifically those having surgery that traditionally loses 10% of the circulatory volume or a 40 gram drop in hemoglobin, to optimize patience hemoglobin preoperatively thus limiting dependence on transfusion post-operatively. In order to be used in this population a patient’s ferritin level must be above 400, and documented not to be falsely elevated.
It is unknown what role B6 plays in the synthesis of red blood cells, specifically the conversion of iron to hemoglobin. It is believed that it has something to do with its role in protein synthesis. If we look at our analogy again: iron being bricks, B12 being the stonemason, hemoglobin being a brick wall, and erythropoietin being the general contractor; I liken B6 to a payroll Clerk. Nothing happens if nobody gets paid, comparatively, iron does not get converted into hemoglobin if B6 isn’t present.
Chemistry 101: Let us start by reviewing basic high school chemistry classes: iron is one of those elements that has two valences. FE + 2 (Ferrous Iron) and FE+3 (Ferric Iron). Our body absorbs ferric iron, this is the iron that is found in Meat. The iron in vegetables and commonly used iron salts is ferrous iron. Acid is needed convert ferrous iron to ferric iron. Vitamin C, ascorbic acid, helps convert vegetable source iron (ferrous iron) to Ferric Iron.
Zinc & Copper
These are trace elements found in the bone marrow. Significant deficits of copper and zinc may cause bone marrow insufficiency and/or bone marrow failure.