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 .