Successful Rechallenge with Darbepoetin Following Immunosuppressive Therapy in a Dialysis Patient with Erythropoietin-Induced Pure Red Cell Aplasia.
- Author:
In Sung SON
1
;
Do Young KIM
;
Soo Youn PARK
;
Ha Young NA
;
Jung Hyun LEE
;
Tae Hwe HEO
;
Young Il JO
Author Information
1. Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea. nephjo@kuh.ac.kr
- Publication Type:Case Report
- Keywords:
Pure red cell aplasia;
Erythropoietin;
Antibodies;
Anemia
- MeSH:
Anemia;
Antibodies;
Candidiasis;
Cyclophosphamide;
Cyclosporine;
Dialysis;
Erythropoietin;
Humans;
Prednisolone;
Prednisone;
Red-Cell Aplasia, Pure;
Renal Dialysis
- From:Korean Journal of Medicine
2013;84(5):742-746
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Patients with erythropoiesis-stimulating agent (ESA)-induced pure red cell aplasia (PRCA) should not routinely be switched to an alternative ESA or to darbepoetin-alpha because anti-erythropoietin (anti-EPO) antibodies cross-react with all kinds of recombinant ESAs. We present a case of ESA-induced PRCA in a 69-year-old man on hemodialysis whose anemia improved with reintroduction of darbepoetin-alpha following immunosuppressive therapy. The patient developed severe anemia after 15 months of subcutaneous administration of erythropoietin-alpha. After the diagnosis of PRCA, erythropoietin-alpha was discontinued and immunosuppressive therapy with a combination of prednisolone and oral cyclophosphamide was initiated. After 4 months of immunosuppressive therapy, the anti-EPO antibody titer was markedly decreased; however, esophageal candidiasis developed. Additional therapy with cyclosporine alone instead of prednisone and cyclophosphamide was performed, and anti-EPO antibody was subsequently not detected. Darbepoetin-alpha was then reintroduced, and the patient's anemia improved without red cell transfusion. In conclusion, ESA-induced PRCA was successfully treated with reintroduction of darbepoetin-alpha following immunosuppressive therapy.
