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KMID : 0882420130840050742
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Korean Journal of Medicine
2013 Volume.84 No. 5 p.742 ~ p.746
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Successful Rechallenge with Darbepoetin Following Immunosuppressive Therapy in a Dialysis Patient with Erythropoietin-Induced Pure Red Cell Aplasia
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Son In-Sung
Kim Do-Young
Park Soo-Youn
Na Ha-Young
Lee Jung-Hyun
Heo Tae-Hwe
Jo Young-Il
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Abstract
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Patients with erythropoiesis-stimulating agent (ESA)-induced pure red cell aplasia (PRCA) should not routinely be switched to an alternative ESA or to darbepoetin-α because anti-erythropoietin (anti-EPO) antibodies cross-react with all kinds of recombinant ESAs. We present a case of ESA-induced PRCA in a 69-year-old man on hemodialysis whose anemia improved with reintroduction of darbepoetin-α following immunosuppressive therapy. The patient developed severe anemia after 15 months of subcutaneous administration of erythropoietin-α. After the diagnosis of PRCA, erythropoietin-α was discontinued and immunosuppressive therapy with a combination of prednisolone and oral cyclophosphamide was initiated. After 4 months of immunosuppressive therapy, the anti-EPO antibody titer was markedly decreased; however, esophageal candidiasis developed. Additional therapy with cyclosporine alone instead of prednisone and cyclophosphamide was performed, and anti-EPO antibody was subsequently not detected. Darbepoetin-α was then reintroduced, and the patient’s anemia improved without red cell transfusion. In conclusion, ESA-induced PRCA was successfully treated with reintroduction of darbepoetin-α following immunosuppressive therapy.
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KEYWORD
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Pure red cell aplasia, Erythropoietin, Antibodies, Anemia
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