Korean J Hematol.  2005 Mar;40(1):45-48. 10.5045/kjh.2005.40.1.45.

Acquired Pure Red Cell Aplasia due to Anti-Erythropoietin Antibodies in a Patient Undergoing Hemodialysis

• Kim MA
• Chang SH
• Maeng KY

• KMID: 2252366
• DOI: http://doi.org/10.5045/kjh.2005.40.1.45

Abstract

A 63-year-old man was placed on hemodialysis for the end-stage of renal disease secondary to renal artery stenosis. He was also regularly given epoetin, subcutaneously, for anemia associated with his renal disease. Rapidly progressing erythropoietin (EPO) resistant anemia and reticulocytopenia developed after 1 year of hemodialysis. The patient required frequent red blood cell transfusions. The bone marrow examination demonstrated selective erythroid hypoplasia. A detailed search for the cause of the erythroblastopenia revealed nothing, with the exception of anti-EPO antibodies (Ab). Pure red cell aplasia (PRCA) was suspected due to the anti-EPO Ab. With the immunosuppressive agent and change to the epoetin-therapy, the patient recovered his hemoglobin and reticulocyte counts. Particular attention should be paid for the possibility of PRCA due to anti-EPO Ab in patients undergoing rHuEPO therapy, with an unexplained recombinant human erythropoietin (rHuEPO) resistant anemia, especially via the subcutaneous route.

Keyword

Hemodialysis; Anti-erythropoietin antibody (Anti-EPO Ab); Pure red cell aplasia (PRCA)

MeSH Terms

Anemia
Antibodies*
Bone Marrow Examination
Erythrocyte Transfusion
Erythropoietin
Humans
Middle Aged
Red-Cell Aplasia, Pure*
Renal Artery Obstruction
Renal Dialysis*
Reticulocyte Count
Antibodies
Erythropoietin

Figure

• 

  Fig. 1. (A) Normal granulopoiesis with few erythroid precursors on bone marrow aspirate smear (Wright stain, 400). (B) Normal granulocytic and megakaryocytic elements with profound erythroblastopenia are present on bone marrow biopsy section (H&E stain, 400).

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