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GSH primarily exists in two states: the reduced form (GSH), which is the dominant state, and the oxidized form, glutathione disulfide (GSSG), where two GSH molecules are connected via a disulfide bond [29,87]

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If elevated, causes of the increased EPO production to consider include heart or chronic pulmonary disease, in which there is desaturation of Hb as it leaves the lungs, or less common causes such as renal cysts, hepatic or cerebellar tumors, uterine leiomyoma, or impaired Hb function caused by heavy smoking, which results in elevated levels of carboxyhemoglobin, which is essentially inert as an oxygen transporter