title: Rapid resolution of EPO-induced pure red cell aplasia after a course of immunoadsorption therapy using protein A columns.
abstract: Pure red cell aplasia (PRCA) is a rare, but important, complication of erythropoietin (EPO) replacement therapy in patients with renal disease. There is no consensus about the best way to treat this condition; however, recent reports indicated that immunosuppressive therapy is beneficial. We report a patient with EPO-induced PRCA treated with a regimen initially designed for antifactor VIII antibodies in patients with hemophilia. This regimen consists of immunoadsorption therapy using protein A columns, followed by oral prednisolone and single bolus infusions of intravenous immunoglobulin G and cyclophosphamide. Shortly after the course, a swift and rapid increase in reticulocyte count was evident; the patient became transfusion independent and has remained so during 2 years of follow-up. By means of this report, we wish to encourage others to consider this option when first-line treatments fail.
authors.affiliation: Department of Medicine, Blekinge Hospital, Karlshamn, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Westerlund
authors.forename: Jan
authors.initials: J
authors.lastname: Kurkus
authors.forename: Mårten
authors.initials: M
authors.lastname: Segelmark
mesh_terms: D000740:Anemia / Q000188:drug therapy / Q000209:etiology; D001803:Blood Transfusion; D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000150:complications / Q000601:surgery / Q000628:therapy; D010530:Peritoneal Dialysis; D011239:Prednisolone / Q000627:therapeutic use; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced / Q000188:drug therapy / Q000628:therapy*; D012074:Remission Induction; D017701:Reticulocyte Count; D016060:Sorption Detoxification; D013205:Staphylococcal Protein A
chemical_list: D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D013205:Staphylococcal Protein A; C103998:epoetin beta; D004921:Erythropoietin; D000068817:Epoetin Alfa; D003520:Cyclophosphamide; D011239:Prednisolone