The association of anti-r-HuEpo-associated pure red cell aplasia with HLA-DRB109-DQB10309

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2009-05, Vol.24 (5), p.1545-1549
• Main Authors: Praditpornsilpa, Kearkiat, Kupatawintu, Pawinee, Mongkonsritagoon, Wichean, Supasyndh, Ouppatham, Jootar, Saengsuree, Intarakumthornchai, Tanin, Pongskul, Cholatip, Prasithsirikul, Wisit, Achavanuntakul, Bunlersak, Ruangkarnchanasetr, Prajej, Laohavinij, Sudsawat, Eiam-Ong, Somchai
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Alleles; anaemia; Anemia - drug therapy; Anemia - etiology; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; anti-r-HuEpo-associated pure red cell aplasia; Antibodies, Anti-Idiotypic - blood; Antibodies, Anti-Idiotypic - immunology; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Case-Control Studies; Chronic Disease; chronic kidney disease; Emergency and intensive care: renal failure. Dialysis management; erythropoietin; Erythropoietin - administration & dosage; Erythropoietin - immunology; Erythropoietin - therapeutic use; Female; Gene Frequency - genetics; Genetic Predisposition to Disease - genetics; HLA genotype; HLA-DQ Antigens - genetics; HLA-DQ Antigens - immunology; HLA-DQ beta-Chains; HLA-DR Antigens - genetics; HLA-DR Antigens - immunology; HLA-DRB1 Chains; Humans; Injections, Subcutaneous; Intensive care medicine; Kidney Diseases - complications; Male; Medical sciences; Middle Aged; Recombinant Proteins; Red-Cell Aplasia, Pure - genetics; Red-Cell Aplasia, Pure - immunology; Retrospective Studies; Risk Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Young Adult
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfn450

Background. Anti-r-HuEpo associated PRCA developed in patients received subcutaneous injection of r-HuEpo for treatment of renal anemia in chronic kidney disease. This adverse immunological effect of r-HuEpo causes sudden loss of r-HuEpo efficacy, low circulating reticulocyte count and bone marrow biopsy shows an absence of erythroid precursor cells with normal cell population of non-erythroid lineage. There are postulation cause of anti-r-HuEpo associated PRCA including genetic factor, immunogenicity factor, storage and handlings factor and formulation of r-HuEpo product. Previous observation of our report showed an aggregation of HLA-DRB1*09 in four anti-r-HuEpo associated PRCA cases. This allele is rare in Caucasian (