title: Resolution of epoetin-induced pure red cell aplasia 2 years later, successful re-challenge with continuous erythropoiesis receptor stimulator.
abstract: Epoetin-induced pure red cell aplasia (PRCA) is most commonly associated with epoetin-a; nevertheless, its occurrence has been reported in epoetin-β and darbepoetin-a. We report a young hemodialysis patient who developed PRCA 2 years after receiving intravenous epoetin-β. Epoetin- induced PRCA was confirmed by bone marrow aspiration, associated with markedly elevated anti-erythropoietin antibody. He was treated with prednisolone and cyclophosphamide for 3 months but continued to be transfusion-dependent. 17 months after the development of PRCA, he was started on intravenous continuous erythropoiesis receptor stimulator (CERA) in view of frequent transfusions. He tolerated the CERA injection well and the hemoglobin level stabilized 7 months later. Repeat bone marrow aspiration confirmed complete resolution of PRCA with disappearance of anti-erythropoietin antibody. To date, he maintained a stable hemoglobin level and has been transfusion-independent for the past 1 year. This is the first in the literature that reported the utilization of CERA in epoetin-induced PRCA. Very low or undetectable level of anti-erythropoietin antibody might be the key to the success of re-challenge strategy in cases of epoetininduced PRCA. Thus, routine checking of anti-erythropoietin antibody before the rechallenge with an alternative erythropoietin product is highly recommended.
authors.forename: Soo Kun
authors.initials: SK
authors.lastname: Lim
authors.forename: Ping Chong
authors.initials: PC
authors.lastname: Bee
authors.forename: Tee Chau
authors.initials: TC
authors.lastname: Keng
authors.forename: Yip Boon
authors.initials: YB
authors.lastname: Chong
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage* / Q000009:adverse effects*; D006397:Hematinics / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011994:Recombinant Proteins / Q000009:adverse effects; D012010:Red-Cell Aplasia, Pure / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; C508420:continuous erythropoietin receptor activator; C103998:epoetin beta; D004921:Erythropoietin; D011092:Polyethylene Glycols