Resolution of epoetin-induced pure red cell aplasia, successful re-challenge with roxadustat

Int J Lab Hematol. 2020 Dec;42(6):e291-e293. doi: 10.1111/ijlh.13325. Epub 2020 Aug 27.

Abstract

The application of erythropoietin (EPO) can bring about a rare but serious complication called anti-EPO antibody-mediated pure red cell aplasia (PRCA). Once the disease is diagnosed, EPO administration should be stopped immediately. However, after the removal of the anti-EPO antibody, treating anaemia in these patients with chronic renal disease with EPO therapy is difficult, as restarting EPO therapy risks the recurrence of anti-EPO antibody-mediated PRCA. A 26-year-old man with anaemia related to renal failure, who was administered recombinant human EPO subcutaneously, developed anti-EPO antibody-mediated PRCA. After removal of antibodies by treatment with corticosteroids and cyclosporine, therapy for anaemia of chronic renal disease with roxadustat achieved good results. Roxadustat is a new type of drug for the treatment of anaemia, and it can stimulate endogenous EPO within or near the physiologic range and increase haemoglobin levels.

Keywords: anti-erythropoietin antibody; haemoglobin; pure red cell aplasia; roxadustat; unusual case.

Publication types

  • Case Reports
  • Letter

MeSH terms

  • Adult
  • Erythropoietin* / administration & dosage
  • Erythropoietin* / adverse effects
  • Glycine / administration & dosage
  • Glycine / analogs & derivatives*
  • Humans
  • Isoquinolines / administration & dosage*
  • Male
  • Red-Cell Aplasia, Pure* / blood
  • Red-Cell Aplasia, Pure* / chemically induced
  • Red-Cell Aplasia, Pure* / drug therapy
  • Renal Insufficiency, Chronic* / blood
  • Renal Insufficiency, Chronic* / therapy

Substances

  • EPO protein, human
  • Isoquinolines
  • Erythropoietin
  • Glycine
  • roxadustat