Response to cyclosporine A in a patient with pure red cell aplasia due to antierythropoietin-alpha antibodies.
Reported cases of pure red cell aplasia (PRCA) from the administration of erythropoietin (EPO)-alpha molecule in the United States are rare, and the optimal treatment is still unknown. We present a patient with end-stage renal disease (ESRD) who became hyporesponsive and later unresponsive to EPO-alpha treatment a few months after initiation of hemodialysis. A comprehensive anemia examination was negative while the patient became transfusion dependent. The diagnosis of EPO-alpha-induced PRCA was confirmed by bone marrow biopsy, by undetectable serum EPO levels following the administration of a large dose of EPO-alpha, and by documenting the presence of EPO-neutralizing antibodies. Administration of cyclosporine A in addition to prednisone enabled the patient to become transfusion and EPO independent. This case further documents the possible occurrence of PRCA with EPO-alpha administration in the United States and reaffirms the potential beneficial effect of cyclosporine A.
Fraer
Mony
M
Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, USA.
Campbell
Adam
A
Sawaya
B Peter
BP
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001323:Autoantibodies / Q000009:adverse effects* / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D004342:Drug Hypersensitivity / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D004359:Drug Therapy, Combination; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000276:immunology*; D006397:Hematinics / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced* / Q000188:drug therapy* / Q000473:pathology; D006435:Renal Dialysis
D000893:Anti-Inflammatory Agents; D001323:Autoantibodies; D006397:Hematinics; D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa; D016572:Cyclosporine; D011241:Prednisone