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KMID : 0191120100250111676
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Journal of Korean Medical Science
2010 Volume.25 No. 11 p.1676 ~ p.1679
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Improvement in Erythropoieis-stimulating Agent-induced Pure Red-cell Aplasia by Introduction of Darbepoetin-α When the Anti-erythropoietin Antibody Titer Declines Spontaneously
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Lee Ha-Jeong
Yang Jae-Seok
Kim Hyo-Sang
Kwon Ju-Won
Oh Kook-Hwan
Joo Kwon-Wook
Kim Yon-Su
Ahn Curie
Han Jin-Suk
Kim Suhng-Gwon
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Abstract
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Anti-erythropoietin antibodies usually cross-react with all kinds of recombinant erythropoietins; therefore, erythropoiesis-stimulating agent (ESA)-induced pure red-cell aplasia (PRCA) is not rescued by different ESAs. Here, we present a case of ESA-induced PRCA in a 36-yr-old woman with chronic kidney disease, whose anemic condition improved following reintroduction of darbepoetin-α. The patient developed progressive, severe anemia after the use of erythropoietin-α. As the anemia did not improve after the administration of either other erythropoietin-α products or erythropoietin-β, all ESAs were discontinued. Oxymetholone therapy failed to improve the transfusion-dependent anemia and a rechallenge with ESAs continuously failed to obtain a sustained response. However, her anemia improved following reintroduction of darbepoetin-α at 3 yr after the initial diagnosis. Interestingly, anti-erythropoietin antibodies were still detectable, although their concentration was too low for titration. In conclusion, darbepoetin-α can improve ESA-induced PRCA when the anti-erythropoietin antibody titer declines and its neutralizing capacity is lost.
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KEYWORD
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Red-Cell Aplasia, Pure, Kidney Failure, Chronic, Erythropoietin, Recombinant, Darbepoetin-alfa
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