Epoetin-induced pure red cell aplasia: diagnosis and treatment.
OBJECTIVE
Antibody-mediated pure red cell aplasia is now recognized as a rare complication of erythropoiesis-stimulating agent therapy. The incidence of this adverse effect peaked in 2002, but new cases still appear sporadically. The aim of this review is to discuss the latest opinions regarding the detection and management of this condition.


RESULTS
The diagnosis of classical erythropoiesis-stimulating agent induced pure red cell aplasia is made by a constellation of clinical features, including severe transfusion-dependent anaemia, reticulocytopenia, low or absent erythroblasts in the bone marrow, and the presence of circulating antierythropoietin antibodies. Recently, some cases have been reported in which the bone marrow findings show red cell hypoplasia rather than aplasia; this may represent earlier presentations of the same condition.


CONCLUSIONS
Management of pure red cell aplasia as a complication of erythropoiesis-stimulating agent therapy consists of stopping the drug and implementing an immunosuppressive regimen to reduce or abolish erythropoietin antibody production. A recent animal study suggested that a possible alternative strategy may be to administer a novel peptide-based erythropoietin receptor agonist called Hematide that does not cross react with antierythropoietin antibodies, and will allow ongoing stimulation of erythropoiesis; this is the subject of a current clinical trial.
Macdougall
Iain C
IC
Department of Renal Medicine, King's College Hospital, London, UK. ian.macdougall@kch.nhs.uk
D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D010455:Peptides / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy
D007166:Immunosuppressive Agents; D010455:Peptides; D011994:Recombinant Proteins; C514771:hematide; D004921:Erythropoietin; D011092:Polyethylene Glycols; D000068817:Epoetin Alfa