[Epoetin-induced pure red-cell aplasia].
A 73-year-old man, a 73-year-old woman, and a 57-year-old man with anaemia due to renal insufficiency were treated with epoetin. After 6-12 months, the haemoglobin level decreased despite dosage increases, after which the patients became dependent on regular transfusions of concentrated erythrocytes. The older man died from peritonitis following diagnostic examination because of the anaemia. The woman died from septic shock, even though epoetin had been replaced by darbepoetin. The haemoglobin level in the younger man returned to normal after the presence of antibodies against epoetin had been demonstrated, he had stopped using the drug, and he had started on immunosuppressive therapy following kidney transplantation. Since 1998, the number of patients with epoetin resistance due to the development of antibodies against the drug (epoetin-induced pure red-cell aplasia) has increased. This complication should be considered in every patient treated with epoetin who experiences unexplained transfusion-dependent anaemia.
Kharagjitsingh
A V
AV
Leids Universitair Medisch Centrum, afd. Klinische Epidemiologie, Postbus 9600, 2300 RC Leiden. a.v.kharagjitsingh@lumc.nl
Dekker
F W
FW
Vandenbroucke
J P
JP
D000368:Aged; D000740:Anemia / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D000906:Antibodies / Q000276:immunology; D004342:Drug Hypersensitivity / Q000276:immunology*; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000009:adverse effects / Q000276:immunology*; D017809:Fatal Outcome; D005260:Female; D006397:Hematinics / Q000276:immunology*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000276:immunology*; D051437:Renal Insufficiency / Q000150:complications
D000906:Antibodies; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin