Immunogenicity profiles of recombinant therapeutic proteins are important to understand because antibodies raised against these molecules may have important clinical sequelae. The purpose of the present study was to demonstrate that a flow cytometric bead array could be used to detect clinically relevant antibodies with specificity to such therapeutics. We chose to evaluate well-characterized specimens from persons treated with epoetin alfa that developed antibody-mediated pure red blood cell aplasia as a means to demonstrate the utility of this platform. Our data show that this assay is capable of detecting anti-epoetin alfa antibodies with a relative antibody concentration of 50 ng/ml, where 25 of 25 sera spiked with antibodies at this concentration scored positive. Moreover, the assay was designed to include positive and negative control beads for each specimen that is processed to ensure the specificity of the signal when detected. Measurement of interassay precision supports quantitative estimates of relative antibody concentrations in the range of 313 to 5,000 ng/ml, where the percent coefficient of variation did not exceed 20%. With respect to clinical specimens, antibodies with specificity for epoetin alfa could be easily detected in a set of specimens from persons with pure red blood cell aplasia that had prior exposure to the EPREX brand of recombinant epoetin alfa. Further development and validation of this approach may facilitate successful widespread application of the method for detection of anti-epoetin alfa antibodies, as well as antibodies directed against other recombinant therapeutic proteins.Immune responses that occur in vivo during administration of a therapeutic protein can induce clinically significant adverse events, including neutralization of both the therapeutic and its endogenous counterpart. Although all antibody isotypes may have this property, manifestations appear to emerge after the class switch to the immunoglobulin G (IgG) isotype (11,17). Clinical management of persons with antibody-neutralized endogenous proteins is not straightforward and most commonly involves the cessation of (drug) administration with supportive care on a case-by-case basis until the circulating concentration of antibodies decreases to nonpathological levels (1). The prolonged half-life of antibodies and plasma cells makes this a long-term issue for the patient.A prototypical example of the ability of a recombinant therapeutic protein to raise cross-reactive, neutralizing antibodies is provided by patients that developed antibody-mediated pure red blood cell aplasia during treatment with recombinant epoetin alfa manufactured and sold outside of the United States. This protein was linked to the induction of neutralizing IgG antibodies and the development of pure red cell aplasia (PRCA) in more than 200 patients since 1998 (1), with the majority of cases attributed to the EPREX brand of recombinant epoetin alfa. Even though the manufacturer of EPREX has since taken action to potentially remediate this situ...