Anti-r-HuEpo associated pure red cell aplasia: Information update.

Abstract

Recombinant human erythropoietin (r-HuEpo) has been used in clinical practice since late 1980s to improve anemia caused by erythropoietin deficiency in chronic kidney disease. Although r-HuEpo improves mortality and morbidity associated with anemia of the patients, the adverse immunological effect of this agent has been reported. After the introduction of r-HuEpo, sporadic cases of anti-r-HuEpo antibody developed with the subcutaneous administration have been identified patients with anti-r-HuEpo associated pure red cell aplasia (PRCA) suddenly experience a loss of efficacy of the treatment and simultaneously have decreases in hemoglobin and circulating reticulocyte count. Bone marrow biopsies from these patients showed absence of erythroid precursor cells with normal cell population of non-erythroid lineage. The established risk factor for anti-r-Hu-Epo associated PRCA included subcutaneous administration, the presence of leachates from uncoated stoppers in formulation containing polysorbate 80, cold chain breaking, and genetic factor. There are no consensus studies for the treatment of anti-r-Hu-Epo associated PRCA. There were evidences that kidney transplantation reverses the condition. Immunosupressive drugs should be given to anti-r- Hu-Epo associated PRCA patients who cannot have kidney transplantation.