For pregnant nontransfusion dependent beta thalassemia patients, when would you consider ESAs for worsening anemia?

Non-transfusion-dependent thalassemia (NTDT) patients tend to have elevated erythropoietin (EPO) levels already, proportionate to their degree of anemia. The basic pathophysiology of thalassemia is ineffective erythropoiesis (IE), in which proliferation, in response to high EPO levels, is already supranormal. Thus, there is already an increase in PFU-E and CFU-E formation, and an increase in proerythroblasts. The problem is that these proerythroblasts are not able to mature and differentiate fur...