Rituximab therapy for pure red cell aplasia due to anti-epoetin antibodies in a woman treated with epoetin-alfa: A case report

被引：8

作者：

Behler C.M. ^{[1
,2
]}

Terrault N.A. ^{[3
]}

Etzell J.E. ^{[4
]}

Damon L.E. ^{[1
]}

机构：

[1] Department of Hematology and Oncology, University of California, San Francisco, CA

[2] Department of Hematology and Oncology, San Francisco Veterans Affairs Medical Center, San Francisco, CA

[3] Department of Gastroenterology, University of California, San Francisco, CA

[4] Department of Laboratory Medicine, University of California, San Francisco, CA

来源：

Journal of Medical Case Reports | / 3卷 / 1期

关键词：

Chronic Kidney Disease; Reticulocyte Count; Nadir Absolute Neutrophil Count; Baseline White Blood Cell; Baseline White Blood Cell Count;

D O I：

10.4076/1752-1947-3-7335

中图分类号：

学科分类号：

摘要：

Introduction. Pure red cell aplasia due to anti-epoetin antibodies is a known complication of epoetin therapy for anemia due to chronic kidney disease. This disease has not previously been well described in the setting of therapy for chronic hepatitis C virus infection. While treatment for pure red cell aplasia due to anti-epoetin antibodies is usually with immunosuppressive therapy such as calcineurin inhibition, the safety of this treatment in chronic hepatitis C virus infection is unknown. To date, little has been published on the efficacy of rituximab on pure red cell aplasia due to anti-epoetin antibodies. Case presentation. This report describes a 65-year-old Asian-American woman who developed pure red cell aplasia from high titer neutralizing anti-epoetin antibodies after epoetin-alfa therapy during ribavirin and peg-interferon treatment for chronic hepatitis C virus infection. We describe the outcome of her treatment with rituximab. The reticulocyte count increased, and anti-epoetin antibody titer decreased with a loss of neutralizing activity in vitro, leading to a reduction in blood transfusions, and eventual resolution of anemia, without reactivation of hepatitis C virus. Conclusion. The diagnosis of pure red cell aplasia from anti-epoetin antibodies should be considered in patients undergoing therapy for chronic hepatitis C virus infection who develop severe anemia after administration of erythropoietin or darbepoetin. Though it is currently an off-label indication, rituximab is a therapeutic option for patients with pure red cell aplasia due to anti-epoetin antibodies. © 2009 licensee BioMed Central Ltd.

引用

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