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

• Published in: International journal of laboratory hematology 2020-12, Vol.42 (6), p.e291-e293
• Main Authors: Wu, Yunzhou, Cai, Xudong, Ni, Jianing, Lin, Xiaomeng
• Format: Article
• Language: English
• Subjects: Adult; Anemia; Antibodies; anti‐erythropoietin antibody; Aplasia; Corticosteroids; Cyclosporins; Erythropoietin; Erythropoietin - administration & dosage; Erythropoietin - adverse effects; Glycine - administration & dosage; Glycine - analogs & derivatives; haemoglobin; Hemoglobin; Humans; Isoquinolines - administration & dosage; Kidney diseases; Letter to the Editor; Letter to the Editors; Male; pure red cell aplasia; Red-Cell Aplasia, Pure - blood; Red-Cell Aplasia, Pure - chemically induced; Red-Cell Aplasia, Pure - drug therapy; Renal failure; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - therapy; roxadustat; unusual case
• ISSN: 1751-5521; 1751-553X
• DOI: 10.1111/ijlh.13325

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.