We report a 3-year case history that describes a 78-year-old woman with recurrent transfusion-dependent
pure red cell aplasia (PRCA) secondary to recombinant epoetin use that was responsive to
immunosuppressant therapy. The patient had
kidney disease of unknown aetiology (estimated glomerular filtration rate of 13 ml/min/1.73 m2) and was not on dialysis. After 16 months of
therapy with subcutaneous
Eprex, she developed anti-
erythropoietin antibody-confirmed PRCA and was started on high dose
prednisone (50 mg per day). Within 5 months, the patient's serum was clear of
antibodies and, under the cover of low dose
prednisone (5-7.5 mg per day),
therapy with a different erythropoiesis-stimulating compound (
Aranesp) was initiated due to persistent
fatigue and anaemia. At 3 months of
therapy, the serum anti-
erythropoietin antibodies remained negative and, due to the patient's requests, and after discussion,
prednisone therapy was discontinued. Unfortunately, 3 months after cessation of
prednisone, a recurrence of PRCA was confirmed by the development of profound anaemia and reappearance of anti-
erythropoietin antibodies in the patient's serum. High dose
prednisone (50 mg per day) was reinstituted, whereupon, 2 months later,
antibodies were again confirmed to be negative. This case report demonstrates the responsiveness of PRCA to simple immunosuppressive therapy, and the ability to introduce different
erythropoiesis-stimulating agents in the presence of such
therapy. It appears that there may be problems associated with discontinuation of immunosuppressive therapy in the presence of sustained
erythropoiesis-stimulating agent therapy in those in whom the condition has occurred previously.