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Successful treatment of chronic refractory pure red cell aplasia with antithymocyte globulin: correlation with in vitro erythroid culture studies.

Abstract
Two contrasting cases of chronic refractory pure red cell aplasia (PRCA) responsive to a commercial preparation of horse antihuman thymocyte globulin (ATG) are reported. Both cases were refractory to trials of cyclophosphamide, corticosteroids, and plasmapheresis. One patient developed a reticulocytosis after a single intravenous infusion of ATG; the other patient responded after administration of 14.7 g of ATG over a 28-day course. At presentation, erythroid progenitors (CFU-E and BFU-E) in one patient were normal; in the second patient, the number of erythroid progenitors was severely reduced. Neither patient had a serum IgG inhibitor to progenitor cells as judged by in vitro erythroid colony studies. Both patients had increased numbers of marrow T-cells and co-culture studies in one case were consistent with T-cell-mediated suppression of erythropoiesis. These studies confirm that ATG is a useful agent in the treatment of refractory PRCA. However, ATG may not act by removal of T suppressor cells in all cases.
AuthorsK F Mangan, R K Shadduck
JournalAmerican journal of hematology (Am J Hematol) Vol. 17 Issue 4 Pg. 417-26 ( 1984) ISSN: 0361-8609 [Print] United States
PMID6238526 (Publication Type: Case Reports, Journal Article, Research Support, U.S. Gov't, P.H.S.)
Chemical References
  • Antilymphocyte Serum
Topics
  • Adult
  • Anemia, Aplastic (immunology, therapy)
  • Antilymphocyte Serum (therapeutic use)
  • Bone Marrow (pathology)
  • Chronic Disease
  • Colony-Forming Units Assay
  • Erythrocytes (pathology)
  • Erythropoiesis
  • Female
  • Humans
  • Middle Aged
  • Phenotype
  • T-Lymphocytes (immunology)
  • T-Lymphocytes, Regulatory (immunology)

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