EPO and hydrops fetalis: Furthermore, deficiencies in vitamin B12 and folic acid, iron deficiency, blood losses caused by aspirin and anticoagulants, an expansion of plasma volume and hemodilution, increased inflammation causing reduced erythropoietin (EPO) production and action, concomitant renal insufficiency, poor nutritional status, intestinal malabsorption due to significant edema are some of the conditions leading to anemia in HF patients.