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KMID : 0882420130840030433
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Korean Journal of Medicine
2013 Volume.84 No. 3 p.433 ~ p.437
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Erythropoietin Antibody-Positive Pure Red Cell Aplasia Diagnosed after Surgical Intervention for Malignant Gastric Ulcer Bleeding
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Yang Hae-Kyung
Lee Kyeong-Soo
Kim In-Ho
Oh Hyun-Jin
Lee Hae-Lim
Lee Kwan-Hyun
Hwang Dae-Yeon
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Abstract
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Rarely, patients on erythropoietin stimulating agent (ESA) therapy develop antibodies that neutralize both ESA and endogenous erythropoietin, resulting in antibody-mediated pure red cell aplasia (PRCA). The sudden development of severe transfusion- dependent anemia requires rapid recognition, the evaluation of PRCA, and prompt intervention after differentiating other causes of anemia, such as iron deficiency, occult bleeding, and infection. Here, we report the case of a 67-year-old male undergoing hemodialysis who presented with the anemia of chronic blood loss from a malignant gastric ulcer. Even after surgical intervention for stomach cancer and increasing the erythropoietin dosage, the anemia was not correctable and required monthly packed red blood cell transfusions. Further evaluation revealed positive erythropoietin antibody, and a bone marrow biopsy showed no red blood cell precursors, supporting the diagnosis of PRCA.
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KEYWORD
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Red-cell aplasia, pure, Erythropoietin
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