Anti-erythropoietin antibodies followed by endogenous erythropoietin production in a dialysis patient.
We present a case of a young girl with end-stage renal disease secondary to anti-glomerular basement membrane disease who was receiving maintenance peritoneal dialysis and developed pure red cell aplasia secondary to anti-erythropoietin (EPO) antibodies. This occurred 13 months after the initiation of EPO alfa therapy for anemia. Initially, the patient required intermittent red blood cell transfusions. After immunosuppressive therapy had been initiated with corticosteroids and cyclosporine, the EPO antibody levels decreased precipitously, associated with an increased level of endogenous EPO production. For the following 6 months, the patient maintained adequate (>10 g/dL) hemoglobin levels and did not require red cell transfusions.
Mattison
Parnell
P
Department of Nephrology, Children's National Medical Center, Washington, DC 20010, USA.
Upadhyay
Kiran
K
Wilcox
Jennifer E
JE
Moudgil
Asha
A
Silverstein
Douglas M
DM
D000740:Anemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D000906:Antibodies / Q000097:blood*; D002675:Child, Preschool; D000068817:Epoetin Alfa; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000009:adverse effects* / Q000096:biosynthesis* / Q000276:immunology; D005260:Female; D006397:Hematinics / Q000009:adverse effects* / Q000276:immunology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D011994:Recombinant Proteins; D012010:Red-Cell Aplasia, Pure / Q000097:blood / Q000139:chemically induced* / Q000276:immunology / Q000628:therapy; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome
D000906:Antibodies; D006397:Hematinics; D006454:Hemoglobins; D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa