Blood loss (haemorrhage) is responsible for nearly 2.5 million trauma-related deaths annually. Haemorrhage can be managed with fluid resuscitation and blood transfusions but, because this treatment combination can lead to haemorrhagic shock and life-threatening organ damage, pharmaceutical interventions that limit this damage are urgently needed. Nandra et al. investigated one possible intervention – pre-treatment with erythropoietin (EPO), a hormone that regulates erythroid progenitor cell proliferation in bone marrow. They show that daily treatment of rats with EPO before induction of haemorrhagic shock attenuates organ injury, mobilises endothelial progenitor cells and activates the Akt-eNOS pro-survival pathway. These results provide new insights into how EPO pre-treatment protects against haemorrhagic shock and suggest that its use before foreseeable haemorrhage (for example, before surgery) could limit the tissue injury associated with haemorrhage and fluid resuscitation. Page 701

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