[Pure red blood cell aplasia associated with neutralizing antibodies against erythropoietin induced by epoetin alfa:a new form of acquired erythroblastopenia in auremic patients].
We report the case of a woman with end-stage renal disease on maintenance hemodialysis and treated with recombinant human erythropoietin (epoetin alfa) administered subcutaneously, who developed a pure red cell aplasia secondary to the development of neutralizing antibodies anti-erythropoietin after 8 months of treatment. Despite epoetin withdrawal and immunosuppressive treatment with corticosteroids and gammaglobulins the patient still has high red blood cell transfusion requirements and undetectable plasma erythropoietin levels. Pure red cell aplasia secondary to the development of neutralizing antibodies anti-erythropoietin is a rare but severe complication associated with the use of recombinant human erythropoietin in uremic patients. In recent years, the incidence of this complication has sharply increased, specially associated with the use of epoetin alfa administered subcutaneously. For this reason, the Spanish Drug Agency has recently contraindicated treating uremic patients with epoetin alfa administered subcutaneously.
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Servicio de Nefrología, Unidad de Trasplante Renal, Hospital Clínic, IDIBAPS, Universidad de Barcelona, Instituto Médico Barcelona. acases@clinic.ub.es
Esforzado
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Mas
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Ricart
M J
MJ
Cruzado
J M
JM
D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects* / Q000276:immunology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000097:blood / Q000139:chemically induced*; D014511:Uremia / Q000097:blood / Q000150:complications / Q000188:drug therapy*
D001323:Autoantibodies; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa