Can a healthy adult have a normal erythropoietin level?

Can Healthy People Have Normal EPO?

Yes, healthy adults have normal erythropoietin (EPO) levels, which range between 10-30 mU/mL (or IU/L). 1, 2

Normal EPO Reference Ranges in Healthy Populations

• The expected serum EPO concentration in healthy adults is 10-30 mU/mL, representing the physiologic baseline for individuals with normal hemoglobin and oxygen delivery. 1, 2

• Research studies confirm these ranges across multiple populations:

  • Japanese healthy subjects: mean 18.6 ± 5.6 mU/mL 3
  • European cohorts: females 11.3 ± 3.4 mU/mL, males 8.0 ± 3.2 mU/mL 4
  • British validation studies: 18 ± 12 mU/mL 5

• No clinically significant sex difference exists in EPO levels among healthy individuals, though some studies show slightly higher values in females (20.5 ± 13 mU/mL) versus males (16.5 ± 10 mU/mL). 3, 5

• Older healthy subjects may have slightly higher EPO levels than younger subjects, but values remain within the normal reference range. 3

Physiologic Context

• EPO is produced by the kidneys in response to tissue hypoxia and regulates red blood cell production to maintain adequate oxygen delivery. 1

• In healthy individuals with normal hemoglobin and adequate tissue oxygenation, EPO production is appropriately regulated within the 10-30 mU/mL range. 1, 2

• This baseline EPO level represents the body's homeostatic set point when no pathologic stimulus (hypoxia, anemia, or autonomous production) is present. 6

Clinical Pitfalls to Avoid

• Do not assume that a "normal" EPO level is always appropriate—context matters. In polycythemia vera, EPO is typically suppressed below the normal range (mean 2.1 ± 1.0 U/L), making a low-normal EPO (e.g., 10-15 mU/mL) potentially inappropriate if hemoglobin is elevated. 7, 8

• A normal EPO level does not exclude secondary polycythemia, as evaluation for cardiopulmonary disease, smoking history, and oxygen saturation remains necessary even when EPO falls within the reference range. 1

• In anemic patients with chronic kidney disease, EPO levels may appear "normal" (within 10-30 mU/mL range) but are inappropriately low relative to the degree of anemia, representing relative EPO deficiency. 4, 5

• Measurement of EPO levels in patients with impaired kidney function and normochromic, normocytic anemia is rarely helpful for clinical decision-making, as the result does not typically alter management. 1