title: Azathioprine-induced pure red cell aplasia: case report and review.
abstract: The major adverse effect of azathioprine is its myelotoxicity, with leukocytes being affected more commonly than the other bone marrow elements. Although megaloblastic change is frequent, reportedly seen in 16% to 82% of bone marrow aspirates, long-term use of azathioprine rarely causes severe anemia. We report a case of refractory pure red cell aplasia resulting from long-term use of azathioprine in a renal transplant recipient and examine the possible underlying mechanisms. There was no response to dose reduction or to erythropoietin administration. However, there was immediate recovery after complete drug withdrawal. A review of the literature revealed that only ten cases of azathioprine-induced red cell aplasia have so far been described, all in transplant recipients.
authors.affiliation: Transplant Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK.
authors.forename: A
authors.initials: A
authors.lastname: Agrawal
authors.forename: N R
authors.initials: NR
authors.lastname: Parrott
authors.forename: H N
authors.initials: HN
authors.lastname: Riad
authors.forename: T
authors.initials: T
authors.lastname: Augustine
mesh_terms: D001379:Azathioprine / Q000009:adverse effects*; D003404:Creatinine / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced*; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D001379:Azathioprine