Acquired Pure Red Cell Aplasia due to Anti-Erythropoietin Antibodies in a Patient Undergoing Hemodialysis

Me-Ae Kim; Se-Ho Chang; Kook-Young Maeng

doi:10.5045/kjh.2005.40.1.45

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Kim, Chang, and Maeng: Acquired Pure Red Cell Aplasia due to Anti-Erythropoietin Antibodies in a Patient Undergoing Hemodialysis

Case Report

Korean J Hematol 2005;40(1):45-48.

Published online: 21 March 2005

DOI: https://doi.org/10.5045/kjh.2005.40.1.45

Acquired Pure Red Cell Aplasia due to Anti-Erythropoietin Antibodies in a Patient Undergoing Hemodialysis

Me-Ae Kim, M.D.¹, Se-Ho Chang, M.D.², Kook-Young Maeng, M.D.¹

¹Department of Laboratory Medicine, Gyeongsang National University Hospital, Jinju, Korea

²Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea

Correspondence to: Me-Ae Kim, M.D. Department of Laboratory Medicine, Gyeongsang National University Hospital 90 Chilam-dong, Jinju 660-702, Korea Tel: +82-55-750-8639, Fax: +82-55-762-2696 E-mail: givmea@hanmail.net

Received 5 January 2005 Revised 31 January 2005 Accepted 2 April 2005

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 63-year-old man was placed on hemodialysis for the end-stage of renal disease secondary to renal artery stenosis. He was also regularly given epoetin, subcutaneously, for anemia associated with his renal disease. Rapidly progressing erythropoietin (EPO) resistant anemia and reticulocytopenia developed after 1 year of hemodialysis. The patient required frequent red blood cell transfusions. The bone marrow examination demonstrated selective erythroid hypoplasia. A detailed search for the cause of the erythroblastopenia revealed nothing, with the exception of anti-EPO antibodies (Ab). Pure red cell aplasia (PRCA) was suspected due to the anti-EPO Ab. With the immunosuppressive agent and change to the epoetin-therapy, the patient recovered his hemoglobin and reticulocyte counts. Particular attention should be paid for the possibility of PRCA due to anti-EPO Ab in patients undergoing rHuEPO therapy, with an unexplained recombinant human erythropoietin (rHuEPO) resistant anemia, especially via the subcutaneous route.

Keywords: Hemodialysis, Anti-erythropoietin antibody (Anti-EPO Ab), Pure red cell aplasia (PRCA)

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Fig. 1.

(A) Normal granulopoiesis with few erythroid precursors on bone marrow aspirate smear (Wright stain, 400). (B) Normal granulocytic and megakaryocytic elements with profound erythroblastopenia are present on bone marrow biopsy section (H&E stain, 400).

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