What is it about?

Drug-based treatments are challenging when a drug’s effect can be measured only days to weeks after administration and drug dose needs to be frequently adjusted based on such measurements. This is the case in the treatment of low red blood cell counts (i.e., anemia) with drugs that stimulate red blood cell formation. We developed a simple mathematical model to understand unwanted effects like cyclic variations in red blood cell count during treatment. Using the model, we show how physiological, pharmacological and treatment-related factors contribute to such disadvantageous behavior.

Featured Image

Why is it important?

Hemoglobin variations in anemia patients have been associated with comorbidities and poor clinical outcomes. Improving anemia treatment in a way that mitigates or avoids cyclic hemoglobin variations can help stabilizing a patient’s red blood cell count and reduce the number of drug dose adjustments during anemia treatment. Our research shows how patient-specific physiological factors (like red blood cell lifespan or drug responsiveness) and treatment-related factors (like drug dosing intervals and dose jumps) affect the tendency of hemoglobin cycling and can help designing better anemia treatments.


This article is the culmination of many years of discussion between a physician, a mathematician and a physicist, each contributing their own unique perspective on hemoglobin cycling. We believe that by complementing clinical experience with systematic modeling, we can expand the range of possible treatment strategies and thus improve the lives of patients suffering from anemia.

David Jörg
Fresenius Medical Care Germany

Read the Original

This page is a summary of: Mechanisms of hemoglobin cycling in anemia patients treated with erythropoiesis-stimulating agents, PLoS Computational Biology, January 2023, PLOS,
DOI: 10.1371/journal.pcbi.1010850.
You can read the full text:

Open access logo


The following have contributed to this page