title: A cluster of Epoetin-associated pure red cell aplasia: clinical features and the possible association of HLA-DRB1*12:02.
abstract: Antibody-mediated pure red cell aplasia is a rare but serious complication in chronic kidney disease patients receiving recombinant human erythropoietin (r-HuEpo). Between April 2012 and May 2013, eight such cases were reported in our institution. Their clinical features were reviewed and their HLA alleles were compared with those of healthy controls. All patients were exposed to epoetin alfa (Eprex®) with polysorbate-80 as stabilizer via subcutaneous route with a mean age of 61.9 years and mean exposure of 11.2 months of r-HuEpo before loss of efficacy. 87.5% of the cases were male and Chinese and received immunosuppression as treatment for pure red cell aplasia. All three of the successfully treated patients are alive compared with only 40% of the transfusion-dependent patients. DRB1*12:02 was more frequently expressed among the cases than healthy controls suggesting a plausible molecular link.
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore.
authors.forename: Chuen Wen
authors.initials: CW
authors.lastname: Tan
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Wei-Chuen
authors.initials: WC
authors.lastname: Tan-Koi
authors.affiliation: Department of Paediatrics, Georgetown University, Washington, DC 20007, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ng
authors.affiliation: Department of Renal Medicine, Singapore General Hospital, Singapore.
authors.forename: Choong Meng
authors.initials: CM
authors.lastname: Chan
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore.
authors.forename: William Ying Khee
authors.initials: WY
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000483:Alleles; D044466:Asian People; D000068817:Epoetin Alfa / Q000009:adverse effects* / Q000627:therapeutic use; D059811:HLA-DRB1 Chains / Q000235:genetics*; D006397:Hematinics / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012010:Red-Cell Aplasia, Pure / Q000139:chemically induced* / Q000188:drug therapy / Q000235:genetics*; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy / Q000235:genetics
chemical_list: D059811:HLA-DRB1 Chains; C553514:HLA-DRB1*12:02 antigen; D006397:Hematinics; D007166:Immunosuppressive Agents; D000068817:Epoetin Alfa
keywords: HLA; pure red cell aplasia; recombinant human erythropoietin