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

Abstract

Reported cases of pure red cell aplasia (PRCA) from the administration of erythropoietin (EPO)-alpha molecule in the United States are rare, and the optimal treatment is still unknown. We present a patient with end-stage renal disease (ESRD) who became hyporesponsive and later unresponsive to EPO-alpha treatment a few months after initiation of hemodialysis. A comprehensive anemia examination was negative while the patient became transfusion dependent. The diagnosis of EPO-alpha-induced PRCA was confirmed by bone marrow biopsy, by undetectable serum EPO levels following the administration of a large dose of EPO-alpha, and by documenting the presence of EPO-neutralizing antibodies. Administration of cyclosporine A in addition to prednisone enabled the patient to become transfusion and EPO independent. This case further documents the possible occurrence of PRCA with EPO-alpha administration in the United States and reaffirms the potential beneficial effect of cyclosporine A.

Antibody-mediated pure red cell aplasia related with epoetin-beta pegol (C.E.R.A.) as an erythropoietic agent: case report of a dialysis patient

“…On the other hand, in cases of antibody-mediated PRCA, antibodies or cytotoxic T lymphocytes attack erythroid precursors [ 1 ]. It is therefore treated with immunosuppressive agents, including corticosteroids, cyclosporine, cyclophosphamide, rituximab, and intravenous immunoglobulin [ 20 , 22 – 24 ]. The reported response rates to cyclosporine and prednisolone (0.5–1.0 mg/kg) in patients with antibody-mediated PRCA related to ESA are 67 and 56%, respectively [ 25 ].…”