Pure red-cell aplasia in a peritoneal dialysis patient with HCV-related cryoglobulinemia in the absence of neutralizing antierythropoietin antibodies.
Pure red-cell aplasia (PRCA) in recombinant human erythropoietin (rHuEpo) treated patients is a matter of growing concern. In most cases, neutralizing anti-EPO antibodies have been detected in patient serum and held responsible for the development of PRCA. We describe a 68-year-old white woman suffering from HCV-related cryoglobulinemia and chronic kidney disease on renal replacement therapy with peritoneal dialysis. Five months after the introduction of epoetin-b therapy she developed a PRCA, as shown by the bone marrow aspirate. Cryocrit rose from 5% to 15% at this time, reticulocyte count fell, while white blood cells and platelets remained within normal values. Epoetin-b therapy was discontinued and steroid treatment was started. The test for anti-erythropoietin antibodies was negative. Hemoglobin and reticulocytes progressively rose and steroid therapy was tapered and eventually stopped, when the cryocrit was 3%. We propose that a relapse in the HCV-related cryoglobulinemia might be held responsible for the erythropoietic marrow failure.
Aterini
Stefano
S
Nephrology Department, Prato Hospital, Prato, Italy. lostbat@libero.it
Fusco
Ismaele
I
Amato
Marcello
M
D000368:Aged; D000906:Antibodies / Q000097:blood; D003449:Cryoglobulinemia / Q000150:complications* / Q000276:immunology / Q000821:virology*; D004921:Erythropoietin / Q000276:immunology / Q000627:therapeutic use; D005260:Female; D006526:Hepatitis C / Q000150:complications* / Q000276:immunology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000276:immunology / Q000628:therapy; D010530:Peritoneal Dialysis; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000209:etiology* / Q000276:immunology
D000906:Antibodies; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin