Altitude pre-acclimatization with an erythropoiesis-stimulating agent
  • Micah Liam Arthur Heldeweg
    Department of internal medicine, Curaçao Medical Center, Willemstad, Curaçao
  • Jonathan Xavier Medina Feliz
    Department of Internal Medicine, Curaçao Medical Center, Willemstad, Curaçao
  • Kenrick Berend
    Department of internal medicine, Curaçao Medical Center, Willemstad, Curaçao


High altitude illness, erythropoiesis-stimulating agent, acclimatization


Introduction: High altitude illness is a complication of rapid ascent above 2,500 m elevation. Ventilatory, circulatory and haematological adjustments, known as acclimatization, occur to maintain adequate delivery of oxygen. Although (non-)pharmaceutical strategies that modulate ventilation and circulation have long been accepted, the haematological approach has not.

Case description: This report describes the application of a comprehensive strategy, including prior pre-acclimatization using an erythropoiesis-stimulating agent (ESA), in two healthy subjects ascending from sea level to 6,268 m. Following ESA administration 30 days prior to ascent, the subjects had a cumulative haemoglobin rise of 7.1% and 11.9%, respectively. Both subjects experienced minimal symptoms during four incremental ascents to the final altitude and no adverse events occurred.

Discussion: This report has limited external validity, lacking both a sample size and controls, but can serve as practical exploration of the concept. Administration of an ESA may be a safe and useful pre-acclimatization strategy but cannot be recommended based on current evidence. More comprehensive research is needed.



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    Published: 2023-04-06
    Issue: 2023: Vol 10 No 4 (view)

    How to cite:
    Heldeweg MLA, Medina Feliz JX, Berend K. Altitude pre-acclimatization with an erythropoiesis-stimulating agent. EJCRIM 2023;10 doi:10.12890/2023_003792.