title: [Pure red cell aplasia induced by erythromycin and furosemide effects on in vitro erythroid colony forming unit (CFU-E)].
abstract: A 84-year-old man was treated with antibiotics including erythromycin and a diuretic (furosemide) because of acute heart failure and pneumonia. During the treatment, he developed moderate anemia (Hb 8.7g/dl). His anemia improved after the treatment. He again developed marked anemia (Hb 6.3g/dl) during the second treatment with erythromycin and furosemide and received blood transfusions. Bone marrow aspiration study revealed severe erythroid hypoplasia (0.2%). He was referred to our hospital, but he was not treated because his hemoglobin levels and reticulocyte count increased (80%) and his bone marrow showed increased erythroblasts (41.5%). His anemia gradually improved without any treatment. We diagnosed the case as drug-induced pure red cell aplasia (PRCA). We cultured bone marrow cells obtained from the present case and four normal healthy volunteers by a plasma clot method to determine the effects of two drugs on the number of erythroid colony forming unit (CFU-E). Furosemide strongly inhibited the CFU-E colony formation in the patient, but the inhibition effect of erythromycin was moderate. Furthermore, CFU-E was markedly suppressed by a combination of erythromycin and furosemide in both patient and control materials. These results indicate that both furosemide and erythromycin were related to the occurrence of PRCA in this patient.
authors.affiliation: Fourth Department of Internal Medicine, Tokai University School of Medicine.
authors.forename: H
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Y
authors.initials: Y
authors.lastname: Umeda
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamura
authors.forename: H
authors.initials: H
authors.lastname: Nozaki
authors.forename: Y
authors.initials: Y
authors.lastname: Ogawa
authors.forename: A
authors.initials: A
authors.lastname: Masumoto
authors.forename: R
authors.initials: R
authors.lastname: Fukuda
authors.forename: H
authors.initials: H
authors.lastname: Kawada
authors.forename: S
authors.initials: S
authors.lastname: Watanabe
authors.forename: S
authors.initials: S
authors.lastname: Yonekura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003114:Colony-Forming Units Assay; D003864:Depression, Chemical; D004357:Drug Synergism; D015672:Erythroid Precursor Cells / Q000166:cytology / Q000187:drug effects*; D004917:Erythromycin / Q000009:adverse effects*; D005665:Furosemide / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced*
chemical_list: D004917:Erythromycin; D005665:Furosemide