Anti-r-HuEpo-associated Pure Red Cell Aplasia in Phramongkutklao Hospital

บทคัดย่อ

Abstract :

Pure red cell aplasia (PRCA) is a condition, in which erythroid precursor cell disappeared from bone marrow. This leads to severe anemia but the production of white blood cell and platelet counts are normal. It can be caused by Parvovirus B19 infection, autoimmune diseases, lymphomas or drugs. PRCA after using erythropoietin stimulating agent (ESA) is caused by antibody to erythropoietin (anti-recombinant human erythropoietin antibody, anti-r-HuEpo). Commonly, it occurs in patients with chronic renal failure who receive ESA by subcutaneous route. These adverse immunological effects of r-HuEpo cause sudden loss of r-HuEpo efficacy, low circulating reticulocyte count and absence of erythroid precursors with normal non-erythroid cell lineage in bone marrow. There are postulated causes of anti-r-HuEpo associated PRCA including genetics, e.g., human leukocyte antigen (HLA), immunogenicity, storage, handlings and formulation of r-HuEpo products. We study PRCA caused by anti-r-HuEpo in Phramongkutklao hospital during 2004-2008. Five patients were diagnosed but only three patients had complete data. The mean age was 71 years old (range: 48-80 years). The mean duration of ESA uses before PRCA was 18 months (range: 4-39 months). Anti- HIV tests were non-reactive and chest films were normal in all patients. The dosages of ESA were 4,000-10,000 units per week by subcutaneous route. The current medications, reticulocyte count, HLA and bone marrow were evaluated. The clinical courses and managements were reported in detail.