Improvement in Erythropoieis-stimulating Agent-induced Pure Red-cell Aplasia by Introduction of Darbepoetin-alpha When the Anti-erythropoietin Antibody Titer Declines Spontaneously.
10.3346/jkms.2010.25.11.1676
- Author:
Hajeong LEE
1
;
Jaeseok YANG
;
Hyosang KIM
;
Ju Won KWON
;
Kook Hwan OH
;
Kwon Wook JOO
;
Yon Su KIM
;
Curie AHN
;
Jin Suk HAN
;
Suhnggwon KIM
Author Information
1. Divison of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
- Publication Type:Case Reports
- Keywords:
Red-Cell Aplasia, Pure;
Kidney Failure, Chronic;
Erythropoietin, Recombinant;
Darbepoetin-alfa
- MeSH:
Adult;
Anemia/drug therapy/etiology;
Antibodies/*blood/immunology;
Bone Marrow Cells/pathology;
Drug Hypersensitivity/immunology;
Erythropoietin/*analogs & derivatives/therapeutic use;
Erythropoietin, Recombinant/adverse effects/*immunology/therapeutic use;
Female;
Glomerulonephritis, IGA/complications;
Hematinics/adverse effects/immunology/*therapeutic use;
Humans;
Kidney Failure, Chronic/complications;
Oxymetholone/therapeutic use;
Red-Cell Aplasia, Pure/chemically induced/*drug therapy/immunology
- From:Journal of Korean Medical Science
2010;25(11):1676-1679
- CountryRepublic of Korea
- Language:English
-
Abstract:
Anti-erythropoietin antibodies usually cross-react with all kinds of recombinant erythropoietins; therefore, erythropoiesis-stimulating agent (ESA)-induced pure red-cell aplasia (PRCA) is not rescued by different ESAs. Here, we present a case of ESA-induced PRCA in a 36-yr-old woman with chronic kidney disease, whose anemic condition improved following reintroduction of darbepoetin-alpha. The patient developed progressive, severe anemia after the use of erythropoietin-alpha. As the anemia did not improve after the administration of either other erythropoietin-alpha products or erythropoietin-beta, all ESAs were discontinued. Oxymetholone therapy failed to improve the transfusion-dependent anemia and a rechallenge with ESAs continuously failed to obtain a sustained response. However, her anemia improved following reintroduction of darbepoetin-alpha at 3 yr after the initial diagnosis. Interestingly, anti-erythropoietin antibodies were still detectable, although their concentration was too low for titration. In conclusion, darbepoetin-alpha can improve ESA-induced PRCA when the anti-erythropoietin antibody titer declines and its neutralizing capacity is lost.
