Triple Immunosuppressive Therapy Can Accelerate the Recovery of Antibody-Mediated Pure Red Cell Aplasia and Allow Successful Concurrent Resumption of Erythropoietin
Prajej Ruangkanchanasetr MD*, Tanomsri Srichaikul MD**, Thanom Supaporn MD*
Affiliation : * Division of Nephrology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand ** Senior hematologist consultant, Vichaiyut Hospital, Bangkok, Thailand
Antibody (Ab)-mediated pure red cell aplasia (PRCA) is a rare hematologic disorder. For the first time here, the authors report the use of combination therapy which consists of mycophenolate mofetil 500-1,000 mg/day, intravenous cyclophosphamide 600 mg monthly and monthly intravenous methylprednisolone 1 gm/day for 2 days followed by oral prednisolone 10 mg/day. A 62-year-old woman developed Ab-mediated PRCA after using subcutaneous erythropoietin-beta 3,000 U weekly for 14 months at the predialysis stage. Ab-mediated PRCA was diagnosed based on (1) the transfusion need of more than 1 unit/wk to keep hemoglobin level stable, (2) corrected reticulocyte count 0.36% and (3) < 5% erythroblasts with normal myeloid cells and megakaryocytes in bone marrow biopsy. Serum assay confirmed the anti-erythropoietin antibody of 230 ng/mL. The patient recovered from PRCA after the triple immunosuppressive therapy for 3 months. The rapid recovery occurred despite the fact that the patient was receiving intravenous erythropoietin-alpha while having the antibody in the serum. The present case describes the acceleration of the recovery and successful resumption of erythropoietin concurrently despite the positive serum anti-erythropoietin antibody.
Keywords : Antibody, Erythropoietin, Mycophenolate mofetil, Pure red cell aplasia
