Improvement in erythropoieis-stimulating agent-induced pure red-cell aplasia by introduction of darbepoetin-α when the anti-erythropoietin antibody titer declines spontaneously.

Abstract

Anti-erythropoietin antibodies usually cross-react with all kinds of recombinant erythropoietins; therefore, erythropoiesis-stimulating agent (ESA)-induced pure red-cell aplasia (PRCA) is not rescued by different ESAs. Here, we present a case of ESA-induced PRCA in a 36-yr-old woman with chronic kidney disease, whose anemic condition improved following reintroduction of darbepoetin-α. The patient developed progressive, severe anemia after the use of erythropoietin-α. As the anemia did not improve after the administration of either other erythropoietin-α products or erythropoietin-β, all ESAs were discontinued. Oxymetholone therapy failed to improve the transfusion-dependent anemia and a rechallenge with ESAs continuously failed to obtain a sustained response. However, her anemia improved following reintroduction of darbepoetin-α at 3 yr after the initial diagnosis. Interestingly, anti-erythropoietin antibodies were still detectable, although their concentration was too low for titration. In conclusion, darbepoetin-α can improve ESA-induced PRCA when the anti-erythropoietin antibody titer declines and its neutralizing capacity is lost.

• Authors: Hajeong Lee, Jaeseok Yang, Hyosang Kim, Ju Won Kwon, Kook-Hwan Oh, Kwon Wook Joo, Yon Su Kim, Curie Ahn, Jin Suk Han, Suhnggwon Kim
• Journal: Journal of Korean medical science (J Korean Med Sci) Vol. 25 Issue 11 Pg. 1676-9 (Nov 2010) ISSN: 1598-6357 [Electronic] Korea (South)
• PMID: 21060762 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antibodies
• Hematinics
• Recombinant Proteins
• Erythropoietin
• Darbepoetin alfa
• Oxymetholone

Topics

• Adult
• Anemia (drug therapy, etiology)
• Antibodies (blood, immunology)
• Bone Marrow Cells (pathology)
• Darbepoetin alfa
• Drug Hypersensitivity (immunology)
• Erythropoietin (adverse effects, analogs & derivatives, immunology, therapeutic use)
• Female
• Glomerulonephritis, IGA (complications)
• Hematinics (adverse effects, immunology, therapeutic use)
• Humans
• Kidney Failure, Chronic (complications)
• Oxymetholone (therapeutic use)
• Recombinant Proteins
• Red-Cell Aplasia, Pure (chemically induced, drug therapy, immunology)