Aplasia pura de células rojas como forma de presentación de lupus eritematoso sistémico / Pure red cell aplasia as a presentig form of systemic lupus erythmatosus

La aplasia pura de células rojas (APCR) es un síndrome definido por anemia normocítica normocrómica, con reticulopenia severa y reducción importante o ausencia absoluta de precursores eritroides en la médula ósea. Ocasionalmente se desencadena en el curso de una colagenopatía o una enfermedad autoinmune. Presentamos el primer caso descripto en la literatura de un varón con APCR como forma de debut de lupus eritematoso sistémico (LES). Se trata de un hombre de 65 años que presentó anemia normocítica normocrómica, ANA 1/5120 y anti-Sm 2,61. Refería úlceras orales, poliartralgias, tumefacción de ambos tobillos y fotosensibilidad. Se realizó estudio de médula ósea con evidencia de hipoplasia de serie roja por paro madurativo a nivel de eritroblasto basófilo, ausencia casi completa de los elementos maduros y contenido muy elevado de proeritroblastos de gran tamaño. Con el diagnóstico de APCR como debut de LES, se lo trató con prednisona con buena respuesta. Podemos concluir que el despistaje de enfermedades sistémicas en pacientes con APCR es esencial para asegurar un correcto manejo y un mejor pronóstico.

Pure red cell aplasia (PRCA) is a syndrome defined by normocytic normochromic anemia with severe reticulocytopenia and marked reduction or absence of erythroid precursors from the bone marrow. Occasionally it is triggered in the course of collagen or autoimmune diseases. We present the first case reported in the literature of a man with PRCA as the onset form of systemic lupus erythematosus (SLE). A 65-year-old man, who presented normocytic normochromic anemia, ANA 1/5120 and anti-Sm 2,61. He reported oral ulcers, polyarthralgia, swelling of both ankles and photosensitivity. Bone marrow examination showed red cell line hypoplasia due to maturation arrest at the level of the basophilic erythroblast, almost absence of mature cells, and a very high content of large proerythroblasts. With the diagnosis of PRCA as the first manifestation of SLE, he was successfully treated with Prednisone. We can conclude that screening for systemic diseases in patients with PRCA is essential to ensure correct management and a better prognosis.

Technical specification for clinical diagnosis and treatment of human parvovirus B19 infection in kidney transplant recipients (2022 edition) / 器官移植

Long-term use of immunosuppressant in kidney transplant recipients leads to poor immune function and infection with various pathogens. In recent years, along with the advancement of detection technique of human parvovirus B19 (HPV-B19) infection and the increasing quantity of kidney transplantation, the infection rate of HPV-B19 after kidney transplantation has been elevated year by year, becoming one of the major causes of pure red cell aplasia (PRCA), affecting the recovery of renal allograft function, and even leading to the injury or poor prognosis of renal allograft. To further standardize the diagnosis and treatment of HPV-B19 infection in kidney transplant recipients, Branch of Organ Transplantation of Chinese Medical Association and National Kidney Transplantation Quality Control Center jointly organized experts to formulate the clinical diagnosis and treatment specification for HPV-B19 infection after kidney transplantation from the perspectives of etiology, epidemiological characteristics, clinical manifestations, diagnosis, prevention, treatment, existing problems and prospects of HPV-B19, aiming to provide guidance for standardized prevention and treatment of HPV-B19 infection post-kidney transplantation in China.

Pure red-cell aplasia secondary to pregnancy: Case report and review of the literature / Aplasia eritroide pura secundaria a embarazo: reporte de un caso y revisión de la literatura

RESUMEN Objetivo: Reportar el caso de una aplasia eritroide pura secundaria al embarazo y hacer una revisión de la literatura sobre el diagnóstico, tratamiento y pronóstico materno y perinatal. Materiales y métodos: Se presenta el caso de una paciente de 24 años, con embarazo de 34 semanas, remitida a un hospital público de referencia regional por anemia en estudio; se realiza biopsia de médula ósea sobre la que se hace diagnóstico de aplasia eritroide pura asociada al embarazo. Recibe manejo con transfusiones seriadas de glóbulos rojos; se realiza cesárea a término, con recién nacido sano; en su puerperio presenta estabilidad de los valores de hemoglobina. Se realizó búsqueda bibliográfica en las bases de datos electrónicas de Medline vía PubMed, LILACS, SciELO y ScienceDirect, con los términos "embarazo", "aplasia pura de células rojas", "pregnancy" y "pure red-cell aplasia". Se incluyeron reportes de caso, series de casos y revisiones bibliográficas en inglés y español, desde enero de 1999 a enero de 2020, de pacientes gestantes con aplasia eritriode pura. Se tomó información sobre el diagnóstico, tratamiento y pronóstico materno y perinatal. Tres autores seleccionaron los estudios por título y resumen. Se hace síntesis descriptiva. Resultados: se identificaron 828 títulos, de los cuales 818 fueron descartados luego de revisar los criterios de inclusión. Se incluyeron diez artículos: seis reportes de casos, tres reportes de caso con revisión de la literatura, un reporte de caso en la modalidad de poster, para un total de 10 casos re- portados. El diagnóstico se basó en bajos niveles de hemoglobina y compromiso de la línea eritriode en la biopsia de médula. El tratamiento en transfusiones de glóbulos rojos y el pronóstico materno-fetal fueron buenos. Conclusión: el diagnóstico de la aplasia eritroide pura en el embarazo requiere biopsia de médula. El pronóstico materno-perinatal es bueno, con soporte transfusional. Se requieren más estudios para evaluar la seguridad y eficacia de los corticosteroides para esta entidad en el embarazo.

ABSTRACT Objective: To report a case of pure red-cell aplasia secondary to pregnancy and to conduct a review of the literature regarding diagnosis and treatment, as well as maternal and perinatal prognosis. Materials and methods: This is the case of a 24-year-old patient at 34 weeks of gestation, referred to a regional public referral hospital due to anemia. Bone marrow biopsy was performed, leading to the diagnosis of pregnancy-related pure red-cell aplasia. The patient received serial red blood cell transfusions. Delivery by Cesarean section at term resulted in a healthy newborn. Hemoglobin values remained stable during the postoperative period. A literature search was conducted in Medline via PubMed, LILACS, SciELO and ScienceDirect using the terms "pregnancy" and "pure red-cell aplasia". Case reports, case series and literature reviews in English and Spanish published between January 1999 and January 2020 that report pregnant women with pure red-cell aplasia were included. Information on diagnosis, treatment and maternal and perinatal prognosis was collected. Three of the authors selected the studies by title and abstract; A descriptive synthesis is provided. Results: Overall, 828 titles were identified; of these,818 were discarded after reviewing the inclusions criteria. Ten articles were included: six case reports, three case reports with literature review, and one case report in the poster modality, for a total number of 10 reported cases. Diagnosis was based on low hemoglobin levels and compromised erythroid cell line in bone marrow biopsy. Treatment consists of red blood cell transfusions, with good maternal and fetal prognosis. Conclusion: Diagnosis of pure red-cell aplasia during pregnancy requires bone marrow biopsy. With transfusion support, maternal perinatal prognosis is good. Further studies are required to assess the safety and efficacy of steroid use in this pregnancy-related condition.

Systematic analysis of cases of lymphoma with autoimmune hemocytopenia reported in the Chinese literature in the past 30 years / 中国肿瘤临床

The authors analyzed 140 cases of malignant lymphoma (ML) associated with autoimmune cytopenia (AIC), including autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), pure red cell aplasia (PRCA), and Evans syndrome. The analysis was based on cases reported in the literature as well as the reference lists of papers in this field from 1989 to 2019 by Chinese scholars. The number of cases involving various non-Hodgkin's lymphoma subtypes was small (n=1-28). Nevertheless, interesting and sometimes unexpected differences were noted among different types of ML and AIC. All types of AIC except AIN were seen to coexist with ML, and the increasing order of incidence was as follows: warm antibody-AIHA >ITP >cold antibody-AIHA>PRCA>Evans syndrome. CAS was only seen with B-cell lymphomas, WA-AIHA, and ITP, Evans syndrome was more frequent in B-cell lymphomas and PRCA predominantly occurred with T-cell lymphomas. Anti-lymphoma treatment seemed to be more effective against AIC than conventional therapy with steroids or immunoglobulin. Although based on a literature survey, this compilation of data indicates a complex relation between lymphoma and AIC and warrants more attention and specific studies.

Next generation sequencing screening for human parvovirus B19 infection after liver transplantation and the analysis of related risk factors / 器官移植

Objective To summarize the screening Methods for human parvovirus (HPV) B19 infection after liver transplantation and analyze the related risk factors. Methods Clinical data of 86 recipients were retrospectively analyzed. According to the Results of next generation sequencing (NGS), all recipients were divided into the HPV B19 infection group and control group. Clinical characteristics, treatment regime and clinical prognosis of patients infected with HPV B19 were analyzed. The risk factors of HPV B19 infection were analyzed using univariate and multivariate Logistic regression model by forward LR step method. Results Nine of the 86 recipients developed fever and progressive anemia with unexplained reasons at approximately 2 weeks after liver transplantation. NGS detection demonstrated that HPV B19 was positive and they were diagnosed with pure red cell aplasia (PRCA) caused by HPV B19 infection. After intravenous immunoglobulins (IVIG) was given and the immunosuppressant therapy was adjusted, the hemoglobin levels in all patients were significantly increased. The Results of multivariate analysis revealed that low serum globulin level in peripheral blood at postoperative 7 d [odds ratio (OR) =0.749, P=0.040] and young age (OR=0.937, P=0.038) were the independent risk factors of HPV B19 infection after liver transplantation. Conclusions HPV B19 infection should be considered in relatively young patients with unexplained hemoglobin decline early after liver transplantation. NGS screening is an effective method for early diagnosis of HPV B19 infection. Low serum globulin level in peripheral blood at postoperative 7 d and young age may be independent risk factors of the incidence of HPV B19 infection.

Progress in diagnosis and treatment of pure red cell aplasia in children / 国际儿科学杂志

Pure red cell aplasia is a rare disease with complex etiology and pathogenesis.It has a variety of treatment methods and therapeutic drugs.This article reviews the etiology,pathogenesis,diagnosis and treatment of pure red cell aplasia in order to help clinicians to have a better understanding of the relevant knowledge of the disease,so as to make timely correct diagnosis and treatment.

Clinical analysis of 100 adult patients with pure red cell aplasia / 中国实用内科杂志

OBJECTIVE: To evaluate clinical characteristics and treatment response of 100 patients with pure red cell aplasia(PRCA).METHODS: We retrospectively analyzed the clinical data of 100 adult patients with acquired PRCA from October2009 to July 2019, and compared the difference in efficacy between idiopathic and secondary patients.RESULTS: 100 patients were evaluated, including 60 idiopathic patients and 40 secondary patients.The most common reasons for secondary PRCA were large granular lymphocytic leukemia(LGLL)(28 cases,70.0%)and thymoma(6 cases, 15.0%). The remission induced regimens included corticosteroids(CS), cyclosporine A(CsA), or other agents, and the response rate were 66.7%,71.4% and 50%, respectively(P=0.336). Secondary PRCA was less effective than idiopathic PRCA(52.5%,78.3%,P=0.007). PRCA related to large granular lymphocytic leukemia was also less effective compared to idiopathic PRCA(46.4%,79.3%,P=0.003). When treated by CsA, idiopathic PRCA was more effective than secondary PRCA and LGLL related PRCA(P=0.001, P=0.000). Logistic regression analysis showed that lower response rate was related to secondary PRCA and LGLL related PRCA.CONCLUSION: The response rate were similar by different induced regimens. Idiopathic PRCA could acquired better response to CsA than secondary, LGLL related PRCA was less effective to treatment.

Eltrombopag for the treatment of refractory acquired pure red cell aplasia / 中国实用内科杂志

OBJECTIVE: To investigate the efficacy of eltrombopag in the treatment of refractory acquired pure red cell aplasia(PRCA). METHODS: Three patients with refractory acquired PRCA treated in the First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital from March 2018 to May 2019 were treated with eltrombopag(75 mg/d). The clinical data were collected for evaluating efficacy and tolerance. RESULTS: The erythrocyte count(P=0.039), hemoglobin concentration(P=0.018) and reticulocyte percentage(P=0.046) in 3 patients were significantly higher than those before treatment. The platelet count was higher than that before treatment(P=0.024). The leukocyte count and absolute neutrophil count increased in 2 patients, and decreased in 1 patient, but still remained in the normal range(P=0.924; P =0.565). Total bilirubin(TBIL) and direct bilirubin(DBIL) increased in 1 case; alanine aminotransferase(ALT), aspartate aminotransferase(AST) and serum creatinine(Scr) increased in 1 case; palpitation occurred in 1 case. All the side effects were alleviated after symptomatic treatment. CONCLUSION: Eltrombopag has certain efficacy and good tolerance in the treatment of refractory acquired PRCA, which is worthy of further exploration.

Two cases of human parvovirus B19 infection-associated anemia after pediatric liver transplantation / 中华器官移植杂志

Objective To explore the diagnosis and treatment of parvovirus B19 infection-associated anemia after pediatric liver transplantation (LT) .Methods The clinical data were retrospectively reviewed for 2 children with severe anemia caused by parvovirus B19 infection after LT .Case 1 was a 2-year-old girl with a weight of 10 .7 kg .Classical orthotopic LT was performed due to ornithine carbamoyltransferase deficiency . Hemoglobin level began to progressively decline since Day 2 post-transplantation .And case 2 was a 5-month-old girl with an age of 5 months and a weight of 7 .2 kg .She underwent classic orthotopic LT for biliary atresia and decompensated liver cirrhosis .Hemoglobin level progressively declined at nearly 2 months post-transplantation . Results In case 1 ,bone marrow aspiration was performed at Day 54 post-transplantation .There was pure red cell aplasia and the detection of microvirus B19 nucleic acid was positive .Intravenous immunoglobulin was prescribed at a dose of 2 .5 g/day for 10 days ,tacrolimus was switched to cyclosporine and hemoglobin level spiked from 62 to 105 g/L after one-month treatment .In case 2 ,hemoglobin decreased to 44 g/L at 2 .5 months post-transplantation and the result of polymerase chain reaction of parvovirus B 19 was 9 .7 × 107 copies/ml .Then intravenous immunoglobulin was dosed at 2 .5 g/day for 10 days and hemoglobin level rose to 122 g/L at 25 days after treatment . Hemoglobin level decreased to 63 g/L again at 4 .5 months post-transplantation .Anemia was corrected by intravenous immunoglobulin injection plus a temporary discontinuation of tacrolimus and a reduced dose of tacrolimus .Conclusions Infection of parvovirus B19 can cause pure red cell aplasia after LT in children . Early diagnosis with intravenous immunoglobulin and modification of immunosuppressive regimen can obtain excellent therapeutic efficacies .

Aplasia pura de células rojas secundaria a infección por parvovirus B19 en paciente VIH positivo / Pure red cell aplasia secondary to parvovirus B19 infection in an HIV positive patient

Resumen La infección crónica por parvovirus B19 en pacientes seropositivos para el virus de inmunodeficiencia humana (VIH) es una causa identificable y tratable de anemia en esta población, que en nuestro medio aún no ha sido muy estudiada. La búsqueda activa de este patógeno en pacientes VIH positivos con anemia grave sin compromiso de otras líneas celulares puede llevar a una mejoría en la calidad de vida en el tiempo y reducción de los costos de la enfermedad para el sistema de salud. Nosotros presentamos el caso de un paciente con síndrome de inmunodeficiencia adquirida y anemia a quien se le identifico parvovirus B19. (Acta Med Colomb 2018; 43: 42-44).

Abstract The chronic infection by parvovirus B19 in seropositive patients for the human immunodeficiency virus (HIV) is an identifiable and treatable cause of anemia in this population, which in our environment has not yet been widely studied. The active search for this pathogen in HIV positive patients with severe anemia without compromising other cell lines can lead to an improvement in the quality of life over time and reduction of the costs of the disease to the health system. We present the case of a patient with acquired immunodeficiency syndrome and anemia who was identified as parvovirus B19. (Acta Med Colomb 2018; 43: 42-44).

Effect of sirolimus on erythropoiesis of K562 cell line and patients with pure red cell aplasia in vitro / 中华血液学杂志

Objective@#To understand the effect of sirolimus on the erythropoiesis of K562 cell line and bone marrow cells from pure red cell aplasia (PRCA) patients and normal controls.@*Methods@#Different concentrations (10, 100, 1 000 nmol/L) of sirolimus were added to the K562 cell line or bone marrow cells from PRCA patients or normal controls and cultured 14 days for BFU-E formation. Meanwhile, sirolimus was also added to the serum treated PRCA bone marrow cells to cultivate for the same priod of time.@*Results@#Neither K562 cells, bone marrow cells from PRCA patients or normal controls showed any difference when sirolimus was added to the culture system for BFU-E. However, BFU-E formation decreased after serum was added in PRCA patients (76.40±22.48 vs 136.33±12.58, t=-4.329, P=0.001) and this suppression of BFU-E was partly corrected by 1 000 nmol/L sirolimus treatment (97.14±15.83 vs 76.40±22.48, P=0.038).@*Conclusions@#Sirolimus may modulate the suppression of erythropoiesis by serum instead of directly stimulate the growth of red blood cells in PRCA patients.

Pure Red Cell Aplasia Associated with Good Syndrome

Pure red cell aplasia (PRCA) and hypogammaglobulinemia are paraneoplastic syndromes that are rarer than myasthenia gravis in patients with thymoma. Good syndrome coexisting with PRCA is an extremely rare pathology. We report the case of a 50-year-old man with thymoma and PRCA associated with Good syndrome who achieved complete PRCA remission after thymectomy and postoperative immunosuppressive therapy, and provide a review of the pertinent literature.

Report of a case of paroxysmal nocturnal hemoglobinuria (PNH) with complex evolution and liver transplant / Relato de um caso de hemoglobinúria paroxística noturna (HPN) com evolução complexa e transplante hepático

ABSTRACT The paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disease, with thrombotic episodes and frequent pancytopenia. We report the case of a 32 year-old female PNH patient with bone marrow aplasia, which followed a complex course, diagnosed with aplastic anemia associated with PNH, evolving in three years with Budd-Chiari syndrome and liver transplantation. Post-transplant complications, hepatic arterial thrombosis, graft rejection, liver retransplantation and treatment of PNH with eculizumab. Clinical stabilization and cessation of symptoms were achieved.

RESUMO Hemoglobinúria paroxística noturna (HPN) é uma doença rara, adquirida, com episódios trombóticos e pancitopenia frequente. Relatamos o caso de uma paciente jovem, 32 anos, sexo feminino, portadora de HPN e aplasia de medula, com evolução complexa e diagnóstico de anemia aplástica associada à HPN, evoluindo em três anos com síndrome de Budd-Chiari e transplante hepático. Complicação pós-transplante, trombose arterial hepática, rejeição do enxerto, retransplante hepático e tratamento da HPN com eculizumab. Obtiveram-se estabilização clínica e cessação dos sintomas.

Pure red cell aplasia caused by human parvovirus B19 infection after renal transplantation:a report of ;2 cases and literature review / 器官移植

Objective To investigate the diagnosis and treatment characteristics of pure red cell aplasia (PRCA)caused by human parvovirus (HPV)B19 infection after renal transplantation.Methods Two cases with PRCA caused by HPV B19-induced after renal transplantation,who were treated in the Department of Organ Transplantation,Nanfang Hospital,Southern Medical University,were summarized.Combined with literature review,the clinical characteristics,diagnostic method,course of treatment and prognosis of such disease were investigated.Results Two renal transplant recipients developed severe anemia early after transplantation with progressive deterioration and failed transfusion therapy.Other causes of anemia were ruled out and two patients were diagnosed as PRCA caused by HPV B19 infection according to bone marrow aspiration and biopsy as well as HPV DNA detection by fluorescent polymerase chain reaction (PCR).The symptoms of anemia were improved significantly after adjustment of immunosuppressive treatment protocol and intravenous immunoglobulin (IVIG).Conclusions For patients with unexplained and progressed anemia early after renal transplantation,especially those complicated with reticulocyte deficiency,the possibility of PRCA caused by HPV B19 infection shall be considered.The results of bone marrow aspiration and fluorescent PCR are the main bases for diagnosing PRCA.Immunosuppressive agents reduction and application of IVIG are the major treatment measures.Most of patients have great prognosis after treatment,but this disease is likely to recur.

Spontaneous Remission in a Teenage Girl with Acquired Pure Red Cell Aplasia / 임상소아혈액종양

Acquired pure red cell aplasia (PRCA) can be induced by various factors such as viral infection, thymoma, connective tissue disease, lymphoma, and adverse drug reactions. PRCA has not been reported in an adolescent in Korea for the past several decades. We recently experienced a case of acquired PRCA in an adolescent. A 14-year-old girl presented with pallor, dizziness, and mild fever. She had isolated normocytic normochromic anemia with reticulocytopenia in the peripheral blood and erythroblastopenia in the bone marrow. She was diagnosed with secondary acquired PRCA presumably induced by Mycoplasma pneumoniae infection during her clinical course, and she experienced spontaneous remission 11 weeks after initial diagnosis. Her clinical and hematologic statuses were normal as far as 20 months after her diagnosis.

Spontaneous Remission in a Teenage Girl with Acquired Pure Red Cell Aplasia / 임상소아혈액종양

Acquired pure red cell aplasia (PRCA) can be induced by various factors such as viral infection, thymoma, connective tissue disease, lymphoma, and adverse drug reactions. PRCA has not been reported in an adolescent in Korea for the past several decades. We recently experienced a case of acquired PRCA in an adolescent. A 14-year-old girl presented with pallor, dizziness, and mild fever. She had isolated normocytic normochromic anemia with reticulocytopenia in the peripheral blood and erythroblastopenia in the bone marrow. She was diagnosed with secondary acquired PRCA presumably induced by Mycoplasma pneumoniae infection during her clinical course, and she experienced spontaneous remission 11 weeks after initial diagnosis. Her clinical and hematologic statuses were normal as far as 20 months after her diagnosis.

Pure Red Cell Aplasia in a Patient with Cri-Du-Chat.

Background: The Cri-Du-Chat syndrome also known as 5p- syndrome is a rare genetic autosomal disorder with the characteristic deletion of the short arm (p) of chromosome 5. To date, hematologic manifestations characteristic of BM failure have not been linked to this syndrome. Aims: To evaluate the safety and efficacy of cyclosporine to treat pure red cell aplasia in the clinical setting of 5p- syndrome. Presentation of Case: We report here a patient with 5p- syndrome who subsequently developed idiopathic pure red cell aplasia. He was treated with cyclosporine 1mg/kg twice a day, and achieved a complete remission, with no toxicities. Conclusion: This case suggests that cyclosporine can be used safely and effectively in such clinical scenario.

Pure red-cell aplasia and autoimmune hemolytic anemia in a patient with acute hepatitis A

Pure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) have rarely been reported as an extrahepatic manifestation of acute hepatitis A (AHA). We report herein a case of AHA complicated by both PRCA and AIHA. A 49-year-old female with a diagnosis of AHA presented with severe anemia (hemoglobin level, 6.9 g/dL) during her clinical course. A diagnostic workup revealed AIHA and PRCA as the cause of the anemia. The patient was treated with an initial transfusion and corticosteroid therapy. Her anemia and liver function test were completely recovered by 9 months after the initial presentation. We review the clinical features and therapeutic strategies for this rare case of extrahepatic manifestation of AHA.

Successful Rechallenge with Darbepoetin Following Immunosuppressive Therapy in a Dialysis Patient with Erythropoietin-Induced Pure Red Cell Aplasia / 대한내과학회지

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.

Successful Erythropoietin Therapy after Alemtuzumab and Cyclosporin a Treatment for Epoetin-Induced Pure Red Cell Aplasia / 대한내과학회지

Pure red cell aplasia (PRCA) in adults is usually idiopathic, although some underlying conditions can cause PRCA. Immunosuppressive therapy (IST) is used to treat PRCA, but IST has side effects and may fail. The anti-CD52 monoclonal antibody alemtuzumab (ALM) was recently used to successfully treat therapy-resistant PRCA. We herein report successful treatment of secondary PRCA after erythropoietin therapy using ALM and cyclosporin A (CsA) in one patient. The total dose of ALM was 60 mg over 3 days (10, 20, and 30 mg, respectively) plus CsA for at least 6 months. The patient achieved a complete response 18 months after ALM-CsA treatment and his treatment could be changed to a different erythropoietin-stimulating agent.