Antierythropoietin antibody-induced pure red cell aplasia: posttransplant evolution

Abstract

Pure red cell aplasia is a rare complication of recombinant human erythropoietin (rHuEPO) treatment, which physicians should consider once the more frequent causes of hyporegenerative anemia have been excluded. To our knowledge, no pediatric cases have been described. In our patient, cyclosporin A treatment enabled a reduction in the number of transfusions and the risk of hyperimmunization. After transplantation, our patient's hemoglobin level has remained normal and stable.

Fellow’ Forum Fellows’ Forum in Dialysis: Response to Cyclosporine A in a Patient with Pure Red Cell Aplasia Due to Antierythropoietin‐α Antibodies

“…However, the long‐term outcome of rechallenging the patients is currently unknown and is not recommended by the manufacturers (20). There also have been reports of PRCA resolution following renal transplantation (3,27–29).…”

“…The possibility of using cyclosporine A as a first‐line therapy is reinforced by other published case reports. In 17 such reported cases, 13 patients recovered with cyclosporine A therapy (23–25,27,30–32). Cyclosporine A down‐regulates antibody production by blocking IL‐2 synthesis and secretion from T helper cells, thus preventing the expansion of T‐cell‐dependent B‐cell activation and antibody production.…”