Recovery from anti-recombinant-human-erythropoietin associated pure red cell aplasia in end-stage renal disease patients after renal transplantation

Abstract

1Division of Nephrology, 2Division of Hematology and 3Laboratory Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand Since 1990, recombinant human erythropoietin (r-HuEPO) has been used for the treatment of anaemia of chronic renal failure (CRF). Correction of anaemia may improve cardiovascular as well as non-cardiovascular morbidity and mortality. Despite these potentially beneficial effects of r-HuEPO, some CRF patients who have previously or are currently using r-HuEPO have been reported to display suspected or confirmed pure red cell aplasia (PRCA) [1,2]. These patients developed an unexplained sudden decrease in their haemoglobin (Hgb) level. Anti-r-HuEPO antibody (Ab), which has been demonstrated in several studies [3–5], seems to be the proximate cause of the PRCA. Currently, there is no firmly established management of anti-r-HuEPO associated with PRCA in CRF patients. Cyclophosphamide and prednisolone appear to be ineffective [6]. We report here that anti-r-HuEPO associated PRCA in end-stage renal disease (ESRD) patients was reversible after kidney transplantation.