Successful Rechallenge with Darbepoetin Following Immunosuppressive Therapy in a Dialysis Patient with Erythropoietin-Induced Pure Red Cell Aplasia / 대한내과학회지
Korean Journal of Medicine
;
: 742-746, 2013.
Article
in Korean
| WPRIM
| ID: wpr-35125
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.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Candidiasis
/
Prednisolone
/
Prednisone
/
Erythropoietin
/
Renal Dialysis
/
Cyclosporine
/
Red-Cell Aplasia, Pure
/
Cyclophosphamide
/
Dialysis
/
Anemia
Limits:
Humans
Language:
Korean
Journal:
Korean Journal of Medicine
Year:
2013
Type:
Article
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