title: Anti-erythropoietin and anti-thrombopoietin antibodies induced after administration of recombinant human erythropoietin.
abstract: Recombinant human erythropoietin (rhEPO) has been successfully used for correcting renal anemia. However, recent studies have raised some concerns about the safety of rhEPO treatment due to its immunogenic side effect - pure red cell aplasia (PRCA). We now report a case of development of anti-EPO neutralizing antibodies (Abs) implicated in thrombocytopenia as well as erythrocytopenia. A 35-year-old man had a history of administering rhEPO (epoetin alfa, epoetin beta and darbepoetin alfa) for 2years to treat renal anemia. The hematological parameters were collected. Anti-EPO, anti-platelet, and anti-thrombopoietin (TPO) Ab assays were performed to test the presence of autoreactive Abs. After performing antibody assays due to severe resistance to rhEPO treatment, a high titer of anti-EPO neutralizing Abs was detected. However, unexpectedly, this patient also showed thrombocytopenia rather than PRCA. We investigated the cause of the marked thrombocytopenia and found anti-TPO Abs in patient serum. To our best knowledge, this is the first report of the development of anti-TPO Abs during rhEPO treatment for anemia.
authors: Department of Internal Medicine, Ilsan Hospital, NHIC, Goyang, Republic of Korea.
authors: Sug Kyun
authors: SK
authors: Shin
authors: Seung Pil
authors: SP
authors: Pack
authors: Jin-Gyo
authors: JG
authors: Oh
authors: Nam Kyu
authors: NK
authors: Kang
authors: Myung Hee
authors: MH
authors: Chang
authors: Yoon Hee
authors: YH
authors: Chung
authors: Sung-Jo
authors: SJ
authors: Kim
authors: Jong Wook
authors: JW
authors: Lee
authors: Tae-Hwe
authors: TH
authors: Heo
mesh_terms: D000328:Adult; D057134:Antibodies, Neutralizing / Q000097:blood*; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors* / Q000276:immunology / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012010:Red-Cell Aplasia, Pure / Q000188:drug therapy; D013921:Thrombocytopenia / Q000139:chemically induced; D013926:Thrombopoietin / Q000037:antagonists & inhibitors* / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D057134:Antibodies, Neutralizing; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa; D013926:Thrombopoietin