1
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Li X, Zhu X, Zhang X, Wang W. Successful treatment of a pure red-cell aplasia patient with γδT cells and clonal TCR gene rearrangement: A case report. Front Immunol 2023; 13:1103448. [PMID: 36726982 PMCID: PMC9885080 DOI: 10.3389/fimmu.2022.1103448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Pure red-cell aplasia (PRCA) is a syndrome associated with reduced erythroid precursors. This report presents the case of an elderly PRCA patient with significantly proliferated γδT cells and clonal T-cell receptor (TCR) gene rearrangement. The cause of this patient's PRCA was confirmed to be an autoimmune disorder rather than malignancy on the basis of flow cytometry, TCR gene rearrangement, and positron emission tomography/computed tomography (PET/CT) findings. Moreover, the γδT cell group identified in this case was captured for the first time under the microscope; this CD4+/CD8- (extremely high CD4/CD8 ratio) population is rare in PRCA patients. Our patient with a monoclonal and polyclonal hybrid of TCR gene rearrangement was sensitive to cyclosporin A (CsA), despite previous reports suggesting that patients with TCR clonal rearrangement may respond poorly to this drug. Overall, this case presents valuable clinical findings for the future diagnosis and management of PRCA caused by autoimmune conditions and further research on γδT cells' autoimmune pathophysiology and gene rearrangement.
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Affiliation(s)
- Xian Li
- Department of Hematology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyi Zhu
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Xiaohong Zhang
- Department of Hematology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Weiqin Wang
- Department of Hematology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China,*Correspondence: Weiqin Wang,
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2
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Nagib AM, Gheith OA, Zahab MA, Balaha MA, Elserwey NA, Sobhy I, Nair P, Al-Otaibi T. Pure Red Cell Aplasia in a Renal Transplant Recipient: Case Report and Review of the Literature. EXP CLIN TRANSPLANT 2022; 20:136-139. [PMID: 35384824 DOI: 10.6002/ect.mesot2021.p66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Severe anemia requiring multiple blood transfusions in the posttransplant period can trigger rejection. The evaluation of anemia among transplant recipients is a challenging task. Awareness should be continued for tacrolimus to manage pure red cell aplasia, but further evidence is needed to prove whether tacrolimus is a real cause of posttransplant anemia. Our case patient, a 66-year-old male patient with end-stage renal disease due to diabetic nephropathy, underwent a preemptive living donor renal transplant in September 2018. He had received a coronary artery bypass graft with transcatheter aortic valve implantation 3 years before renal transplant. Initially, he was maintained on prednisolone, mycophenolate mofetil, and tacrolimus after basiliximab induction. One month later, he presented with low cardiac output symptoms. His complete blood count showed normocytic normochromic anemia with reticulocytopenia (his hemoglobin level dropped from 112 to 69 g/L), which necessitated regular blood transfusions. His iron profile, serum folate, and vitamin B12 were within normal limits, and he had negative hemolytic and autoimmune screening tests. A bone marrow biopsy revealed acquired pure red cell aplasia, which was most likely drug induced as viral profiles were negative for parvovirus B19, cytomegalovirus, and Epstein-Barr virus. The patient was managed by discontinuing mycophenolate mofetil, and the steroid dose was increased up to 20 mg/day but without improvement. With tacrolimus then considered, 3 weeks after presentation, we replaced tacrolimus with cyclosporine. Complete blood count follow-up showed improvement without any need for further blood transfusions. After 1 month of cyclosporine maintenance, mycophenolate mofetil was resumed with a steady increase of hemoglobin up to 150 g/L and serum creatinine of 122 μmol/L. Pure red cell aplasia is a rare disorder among renal transplant recipients, which could be induced by maintenance tacrolimus therapy.
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Affiliation(s)
- Ayman M Nagib
- From the Nephrology Department, Hamed Al-Essa Organ Transplant Center, Sabah Area, Kuwait.,From the Nephrology Department of Dialysis and Transplantation, Urology Nephrology Center, Mansoura University, Mansoura, Egypt
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3
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Santacruz JC, Mantilla MJ, Rueda I, Pulido S, Rodriguez-Salas G, Londono J. A Practical Perspective of the Hematologic Manifestations of Systemic Lupus Erythematosus. Cureus 2022; 14:e22938. [PMID: 35399432 PMCID: PMC8986464 DOI: 10.7759/cureus.22938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with an unknown etiology that can affect any organ or system of the human body. Hematological, renal, or central nervous system manifestations in these patients result in great morbidity because high doses of glucocorticoids, cytotoxic medications, or biological drugs are required to control these manifestations. It is noteworthy that hematological involvement predominates during the first years of the disease and tends to last over time, with the premise that it may be the initial manifestation of the disease. Clear examples of this are the cases of hemolytic anemia and immune thrombocytopenia that can be initially classified as idiopathic or primary to be later classified as secondary when associated with infections, medications, neoplasms, or autoimmune diseases. The spectrum of hematologic manifestations in SLE is very broad, including lymphopenia, anemia, thrombocytopenia, or pancytopenia. In some cases, lymphadenopathy and splenomegaly are also identified. The vast majority of these manifestations denote high disease activity. However, many of these alterations have a multifactorial cause that must be taken into account to adopt a more complete therapeutic approach. The objective of this review is to characterize in detail the hematological manifestations of SLE to offer clinicians a practical vision of its diagnosis and treatment.
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4
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Weerasinghe S, Karunathilake P, Ralapanawa U, Jayalath T, Abeygunawardena S, Rathnayaka M. Pure red cell aplasia secondary to rheumatoid arthritis: a case report. J Med Case Rep 2021; 15:578. [PMID: 34872595 PMCID: PMC8647461 DOI: 10.1186/s13256-021-03141-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/04/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis is a common autoimmune disease with many extra-articular manifestations. Pure red cell aplasia is a rare manifestation of rheumatoid arthritis and is sparsely documented in the literature, with a variable clinical outcome following immunosuppressive therapy. CASE PRESENTATION A 63-year-old Sinhalese female presented with transfusion-dependent anemia associated with deforming inflammatory arthritis. She also had leukopenia, right subclavian venous thrombosis, and generalized lymphadenopathy. The diagnosis of rheumatoid arthritis following initial clinical workup and additional blood and bone marrow investigations revealed pure red cell aplasia as a secondary manifestation of rheumatoid arthritis after excluding other secondary causes, such as infections, thymoma, thrombophilic conditions, and hematological malignancy. She responded well to oral prednisolone, cyclosporine A, and hydroxychloroquine, and she attained complete recovery in 2 months. CONCLUSION Pure red cell aplasia is a disabling illness that may lead to transfusion-dependent anemia, which may occur due to rare extrapulmonary manifestation of rheumatoid arthritis. The diagnosis of pure red cell aplasia secondary to rheumatoid arthritis may be challenging where hematological investigations, including bone marrow biopsy, will aid in the diagnosis, and early diagnosis and treatment will bring about a better outcome.
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Affiliation(s)
| | | | - Udaya Ralapanawa
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Thilak Jayalath
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | | | - Manel Rathnayaka
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
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5
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Fattizzo B, Bellani V, Pasquale R, Giannotta JA, Barcellini W. Large Granular Lymphocyte Expansion in Myeloid Diseases and Bone Marrow Failure Syndromes: Whoever Seeks Finds. Front Oncol 2021; 11:748610. [PMID: 34660312 PMCID: PMC8517436 DOI: 10.3389/fonc.2021.748610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022] Open
Abstract
Large granular lymphocytes (LGL) are lymphoid cells characterized by either a T-cell or a natural killer phenotype whose expansion may be reactive to toxic, infectious, and neoplastic conditions, or result from clonal selection. Recently, the higher attention to LGL clones led to their detection in many clinical conditions including myeloid neoplasms and bone marrow failures. In these contexts, it is still unclear whether LGL cells actively contribute to anti-stem cell autoimmunity or are only a reaction to dysplastic/leukemic myelopoiesis. Moreover, some evidence exists about a common clonal origin of LGL and myeloid clones, including the detection of STAT3 mutations, typical of LGL, in myeloid precursors from myelodysplastic patients. In this article we reviewed available literature regarding the association of LGL clones with myeloid neoplasms (myelodysplastic syndromes, myeloproliferative neoplasms, and acute myeloid leukemias) and bone marrow failures (aplastic anemia and pure red cell aplasia, PRCA) focusing on evidence of pathogenic, clinical, and prognostic relevance. It emerged that LGL clones may be found in up to one third of patients, particularly those with PRCA, and are associated with a more cytopenic phenotype and good response to immunosuppression. Pathogenically, LGL clones seem to expand after myeloid therapies, whilst immunosuppression leading to LGL depletion may favor leukemic escape and thus requires caution.
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Affiliation(s)
- Bruno Fattizzo
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Bellani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Raffaella Pasquale
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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6
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Magendiran B, Jose A, Kolar Vishwanath V, Bammigatti C. Immune-mediated Coombs negative intravascular haemolysis in systemic lupus erythematosus (SLE). BMJ Case Rep 2021; 14:e244459. [PMID: 34417246 PMCID: PMC8381295 DOI: 10.1136/bcr-2021-244459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/03/2022] Open
Abstract
A 27-year-old woman presented with a history of excessive hair loss, loss of appetite, loss of weight, amenorrhoea and loss of axillary and pubic hair for 6 months followed by fever and vomiting for 5 months and abdominal pain for 1 month. During the course of her illness, the patient developed intravascular haemolysis as evidenced by a drop in haemoglobin, indirect hyperbilirubinaemia, raised lactate dehydrogenase (LDH) and haemoglobinuria. Examination revealed severe pallor, mild icterus, elevated jugular venous pressure, generalised lymphadenopathy and hyperpigmentation. Investigations revealed severe anaemia, indirect hyperbilirubinaemia, raised LDH and negative Coombs test. Antinuclear antibody and anti-dsDNA, anti-Sm and anti-SS-A/Ro antibodies were positive and complement C3 was low. The patient was diagnosed to have systemic lupus erythematosus and immune-mediated intravascular haemolysis and was treated with prednisolone and hydroxychloroquine. Haemolysis resolved following steroid therapy, and during follow-up, there were no further episodes of haemolysis.
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Affiliation(s)
- Bhoobalan Magendiran
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Augustine Jose
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vinod Kolar Vishwanath
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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7
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Mandal S, Shah R, Lowry P. A Rare Presentation of Parvovirus Induced Pure Red Cell Aplasia in Elderly Male With Inclusion Body Myositis. Cureus 2020; 12:e12095. [PMID: 33489512 PMCID: PMC7805531 DOI: 10.7759/cureus.12095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a rare condition leading to erythroid bone marrow failure. Parvovirus is one of the rare causes of PRCA in older adults. We present a 73-year-old man on high dose prednisone who presented with rapid functional decline and shortness of breath and was found to have normocytic normochromic anemia with low reticulocyte counts. On further workup, he was found to have elevated immunoglobulin M (IgM) titer of parvovirus B-19 antibody. The patient was managed with supportive care with blood transfusion, hydration and had improvement in his symptoms.
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Affiliation(s)
- Shobha Mandal
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Ravindra Shah
- Internal Medicine, Spinal Pain and Rehabilitation Medicine PC, New York, USA
| | - Philip Lowry
- Hematology and Oncology, Guthrie Robert Packer Hospital, Sayre, USA
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8
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Abstract
Pure red blood cell aplasia (PRCA) is one of the uncommon causes of anemia. Drug-induced PRCA is even more infrequent. Only a few drugs are implicated in PRCA. Isoniazid is a widely used drug for the treatment of tuberculosis all over the world. It is known to cause hepatotoxicity, but in rare instances, it can lead to PRCA. A 72-year-old Caucasian male, who was started on isoniazid after the diagnosis of latent tuberculosis, presented two months later with episodes of syncope to primary care physician's office. The initial blood work showed severe anemia. There were no signs of acute or chronic gastrointestinal blood loss, and the stool hemoccult test was negative. Iron, vitamin B12, folate, lactate dehydrogenase, bilirubin, transaminases, and erythropoietin were within normal limits. Peripheral blood smear showed normochromic and normocytic anemia. A reticulocyte count was less than 1,000 per microliter. Thymoma, human immunodeficiency virus, and parvovirus B19 were ruled out. Further work-up with bone marrow biopsy confirmed pure red blood cell aplasia. A detailed review of recently started medications revealed isoniazid as the offending drug. Isoniazid was stopped. Reticulocyte count and bone marrow recovered a few days after stopping with eventual improvement in hemoglobin level, thus confirming the diagnosis of isoniazid induced red blood cell aplasia. Isoniazid is the first-line therapy for tuberculosis. Rarely, it can cause pure red blood cell suppression and severe anemia, an untoward effect, worth remembering.
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Affiliation(s)
- Waqas Azhar
- Hospital Medicine, Springfield Clinic, Springfield, USA.,Internal Medicine, Memorial Medical Center, Springfield, USA.,Internal Medicine, Saint John Hospital, Springfield, USA.,Internal Medicine, Southern Illinois University School of Medicine, Springfield, USA
| | - Fawwad Zaidi
- Hematology/Oncology, Southern Illinois University School of Medicine, Springfield, USA
| | - Abdul Hannan
- Hematology/Oncology, Southern Illinois University School of Medicine, Springfield, USA
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9
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Pure Red Cell Aplasia with Del(20q) Sensitive for Immunosuppressive Treatment. Case Rep Hematol 2020; 2020:1262038. [PMID: 32082654 PMCID: PMC6995481 DOI: 10.1155/2020/1262038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/13/2019] [Accepted: 12/28/2019] [Indexed: 11/17/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a rare syndrome that only affects the erythroid lineage. It is defined by a normocytic, normochromic anemia with a marked reticulocytopenia and severe reduction or absence of erythroid precursors in the bone marrow. Treatment of primary, idiopathic PRCA is immunosuppressive therapy. Although it is rare, isolated cytogenetic abnormalities can be seen in PRCA, and abnormal karyotype is associated with poor response to immunosuppressive therapy and poor prognosis. We describe a 77-year-old male with primary, idiopathic PRCA and a deletion of chromosome 20q, del(20q), in the bone marrow cells. He was successfully treated with immunosuppressive therapy and became transfusion-independent. The same cytogenetic abnormality has also been described in a few other reports; taken together, these observations suggest that del(20q) may represent a recurrent cytogenetic abnormality in PRCA. Our case report clearly illustrates that even patients with primary PRCA and an abnormal karyotype can respond to immunosuppression and become transfusion-independent.
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10
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Qiu ZY, Qin R, Tian GY, Wang Y, Zhang YQ. Pathophysiologic Mechanisms And Management Of Large Granular Lymphocytic Leukemia Associated Pure Red Cell Aplasia. Onco Targets Ther 2019; 12:8229-8240. [PMID: 31632073 PMCID: PMC6781944 DOI: 10.2147/ott.s222378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/13/2019] [Indexed: 12/31/2022] Open
Abstract
Large granular lymphocytic leukemia (LGLL) is a chronic clonal lymphoproliferative disease of mature T or NK cells, and produces a variety of hematological abnormalities. Pure red cell aplasia (PRCA) is a rare haematological disease and is one of the most common complications of LGLL. LGLL-associated PRCA may represent a relatively indolent type and may be more common than reported, but its natural history and clinical course have not been well described. The ethnic origin of the patients is an important consideration in determining the relationship between PRCA and LGLL. Guidelines and progresses for management of LGLL-associated PRCA rely on accumulation of empirical experiences, integrative analyses of several cases and clinical trials. The purpose of this review is to evaluate occurrence, possible mechanisms, diagnosis, clinical features, treatments and outcomes of LGLL-associated PRCA.
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Affiliation(s)
- Zhi-Yuan Qiu
- Department of Oncology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu, People's Republic of China
| | - Rong Qin
- Department of Oncology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu, People's Republic of China
| | - Guang-Yu Tian
- Department of Oncology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu, People's Republic of China
| | - Yan Wang
- Department of Oncology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu, People's Republic of China
| | - Ye-Qing Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, People's Republic of China
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11
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Noronha SA. Aplastic and Hypoplastic Anemias. Pediatr Rev 2018; 39:601-611. [PMID: 30504252 DOI: 10.1542/pir.2017-0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Suzie A Noronha
- Division of Pediatric Hematology/Oncology, University of Rochester, Rochester, NY
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12
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Holla SK, Achappa B, Manibettu Raguram P, Yerramsetti S. Isoniazid-induced pure red cell aplasia. BMJ Case Rep 2018; 2018:bcr-2018-226134. [PMID: 30297494 DOI: 10.1136/bcr-2018-226134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The pure red cell aplasia (PRCA) is an uncommon side effect of isoniazid. We describe a 28-year-old man who developed a severe anaemia caused by PRCA. The patient received antituberculous therapy including isoniazid for his pulmonary tuberculosis. On discontinuation of isoniazid, the anaemia recovered promptly. PRCA should be considered in case of unexplained anaemia during isoniazid treatment.
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Affiliation(s)
- Subraya Krishna Holla
- Department of Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Basavaprabhu Achappa
- Department of Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Pavan Manibettu Raguram
- Department of Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka, India
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13
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Abongwa C, Abusin G, El-Sheikh A. Successful treatment of tacrolimus-related pure red cell aplasia and autoimmune hemolytic anemia with rituximab in a pediatric cardiac transplant patient. Pediatr Blood Cancer 2017; 64. [PMID: 28598573 DOI: 10.1002/pbc.26674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 11/12/2022]
Abstract
Acquired pure red cell aplasia (PRCA) and autoimmune hemolytic anemia (AIHA) are rare complications of immunosuppression in pediatric solid organ transplant patients. We report a 14-month-old female child who developed Coombs positive hemolytic anemia and reticulocytopenia while on tacrolimus after cardiac transplantation. She was successfully treated with rituximab after failing treatment with corticosteroids and intravenous immunoglobulins. Clinicians should consider PRCA differential diagnosis in a patient presenting with reticulocytopenia and hemolysis. In addition, the coexistence of PRCA with AIHA, and the response to therapy with rituximab, supports a common immune-mediated pathogenesis for both disorders.
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Affiliation(s)
- Chenue Abongwa
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Loma Linda University, Loma Linda, California
| | - Ghada Abusin
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
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14
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Saito Y, Sawada Y, Koga Y, Sunaga N, Tsukagoshi Y, Hachisu Y, Osaki T, Sakurai R, Kaira K, Ono A, Sato K, Koiso H, Oyama T, Hisada T, Yamada M. Isoniazid-induced Pure Red Cell Aplasia in a Patient with Sarcoidosis: A Patient Summary and Review of the Literature. Intern Med 2017; 56:2753-2757. [PMID: 28924112 PMCID: PMC5675938 DOI: 10.2169/internalmedicine.8379-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 41-year-old woman treated with isoniazid (INH) for latent tuberculosis infection and an oral corticosteroid for sarcoidosis developed severe anemia two months after initiating INH. A bone marrow examination showed erythroblastopenia, and a diagnosis of INH-induced pure red cell aplasia (PRCA) was made. Her reticulocyte count and hemoglobin levels improved two weeks after discontinuation of INH. A literature review of INH-induced PRCA shows that it occurs very rarely in the context of autoimmune disorders. This report describes a case of INH-induced PRCA occurring in a patient with sarcoidosis.
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Affiliation(s)
- Yasuyuki Saito
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Yuri Sawada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Yasuhiko Koga
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Noriaki Sunaga
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
- Oncology Center, Gunma University Hospital, Japan
| | - Yusuke Tsukagoshi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Yoshimasa Hachisu
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Takashi Osaki
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Reiko Sakurai
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Kyoichi Kaira
- Department of Oncology Clinical Development, Gunma University Graduate School of Medicine, Japan
| | - Akihiro Ono
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Ken Sato
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Hiromi Koiso
- Infection Control and Prevention Center, Gunma University Hospital, Japan
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Japan
| | - Takeshi Hisada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | - Masanobu Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
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15
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Hirai K, Ookawara S, Miyazawa H, Ito K, Ueda Y, Kaku Y, Hoshino T, Kimura SI, Yoshida I, Kakuta S, Morishita Y, Tabei K. Successful treatment of a hemodialyzed patient with pure red cell aplasia associated with epoetin beta pegol therapy with cyclosporine. CEN Case Rep 2017; 5:78-82. [PMID: 28509169 DOI: 10.1007/s13730-015-0196-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022] Open
Abstract
A 42-year-old man with end-stage renal failure had been receiving hemodialysis therapy since April 2009. Initially, darbepoetin alfa was administered to treat his renal anemia. After treatment was switched to epoetin beta pegol, the patient's hemoglobin levels rapidly decreased. He was diagnosed with pure red cell aplasia (PRCA) based on the results of a bone marrow examination. Epoetin beta pegol was strongly suspected to be the cause of the PRCA, and although he tested negative for anti-epoetin beta pegol antibodies, epoetin beta pegol was discontinued and cyclosporine therapy was initiated. Thereafter, his hemoglobin levels increased, and his anemia dramatically improved after 3 months.
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Affiliation(s)
- Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Haruhisa Miyazawa
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yuichiro Ueda
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yoshio Kaku
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Taro Hoshino
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Izumi Yoshida
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | | | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Kaoru Tabei
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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16
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Abstract
Many processes lead to anemia. This review covers anemias that are less commonly encountered in the United States. These anemias include hemoglobin defects like thalassemia, bone marrow failure syndromes like aplastic anemia and pure red cell aplasia, and hemolytic processes such as paroxysmal nocturnal hemoglobinuria. The pathogenesis, diagnostic workup, and treatment of these rare anemias are reviewed.
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Affiliation(s)
- Molly Maddock Daughety
- Division of Hematology/Medical Oncology, Department of Medicine, Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97201-3098, USA
| | - Thomas G DeLoughery
- Division of Hematology/Medical Oncology, Department of Medicine, Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97201-3098, USA; Division of Hematology/Medical Oncology, Department of Medicine, Knight Cancer Institute, Oregon Health and Science University, MC L586, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
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17
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Oral cyclophosphamide was effective for Coombs-negative autoimmune hemolytic anemia in CD16+CD56− chronic lymphoproliferative disorder of NK-cells. Int J Hematol 2016; 105:854-858. [DOI: 10.1007/s12185-016-2170-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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18
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Velo-García A, Castro SG, Isenberg DA. The diagnosis and management of the haematologic manifestations of lupus. J Autoimmun 2016; 74:139-160. [DOI: 10.1016/j.jaut.2016.07.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 12/21/2022]
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19
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Korde N, Zhang Y, Loeliger K, Poon A, Simakova O, Zingone A, Costello R, Childs R, Noel P, Silver S, Kwok M, Mo C, Young N, Landgren O, Sloand E, Maric I. Monoclonal gammopathy-associated pure red cell aplasia. Br J Haematol 2016; 173:876-83. [PMID: 26999424 PMCID: PMC5549779 DOI: 10.1111/bjh.14012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/25/2015] [Indexed: 01/24/2023]
Abstract
Pure red cell aplasia (PRCA) is a rare disorder characterized by inhibition of erythroid precursors in the bone marrow and normochromic, normocytic anaemia with reticulocytopenia. Among 51 PRCA patients, we identified 12 (24%) patients having monoclonal gammopathy, monoclonal gammopathy of undetermined significance or smouldering multiple myeloma, with presence of monoclonal protein or abnormal serum free light chains and atypical bone marrow features of clonal plasmacytosis, hypercellularity and fibrosis. Thus far, three patients treated with anti-myeloma based therapeutics have responded with reticulocyte recovery and clinical transfusion independence, suggesting plasma cells play a key role in the pathogenesis of this specific monoclonal gammopathy-associated PRCA.
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Affiliation(s)
- Neha Korde
- Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Multiple Myeloma Section, Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yong Zhang
- Multiple Myeloma Section, Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kelsey Loeliger
- National Heart, Lung, and Blood Institute, Hematology Branch, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Poon
- National Heart, Lung, and Blood Institute, Hematology Branch, National Institutes of Health, Bethesda, MD, USA
| | - Olga Simakova
- Office of Blood Research and Review/Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Adriana Zingone
- Multiple Myeloma Section, Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rene Costello
- Multiple Myeloma Section, Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Richard Childs
- National Heart, Lung, and Blood Institute, Hematology Branch, National Institutes of Health, Bethesda, MD, USA
| | - Pierre Noel
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Samuel Silver
- Internal Medicine/Hematology-Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Mary Kwok
- Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Clifton Mo
- Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Neal Young
- National Heart, Lung, and Blood Institute, Hematology Branch, National Institutes of Health, Bethesda, MD, USA
| | - Ola Landgren
- Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Multiple Myeloma Section, Metabolism Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elaine Sloand
- National Heart, Lung, and Blood Institute, Hematology Branch, National Institutes of Health, Bethesda, MD, USA
| | - Irina Maric
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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20
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Pure White Cell Aplasia and Necrotizing Myositis. Case Rep Hematol 2016; 2016:4161679. [PMID: 27073704 PMCID: PMC4814688 DOI: 10.1155/2016/4161679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/02/2016] [Indexed: 01/22/2023] Open
Abstract
Pure white cell aplasia (PWCA) is a rare hematologic disorder characterized by the absence of neutrophil lineages in the bone marrow with intact megakaryopoiesis and erythropoiesis. PWCA has been associated with autoimmune, drug-induced, and viral exposures. Here, we report a case of a 74-year-old female who presented with severe proximal weakness without pain and was found to have PWCA with nonspecific inflammatory necrotizing myositis and acute liver injury on biopsies. These findings were associated with a recent course of azithromycin and her daily use of a statin. Myositis improved on prednisone but PWCA persisted. With intravenous immunoglobulin and granulocyte-colony stimulating factor therapies, her symptoms and neutrophil counts improved and were sustained for months.
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21
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Kwon SE, Kwon HW, Kim DH, Moon Y, Hong YJ, Kim SK. Spontaneous Remission in a Teenage Girl with Acquired Pure Red Cell Aplasia. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2015. [DOI: 10.15264/cpho.2015.22.2.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sung Eun Kwon
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Hye Won Kwon
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Dong Hyun Kim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Yeonsook Moon
- Department of Laboratory Medicine, Inha University School of Medicine, Incheon, Korea
| | - Young Jin Hong
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
| | - Soon Ki Kim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
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22
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Yang G, Cheng Q, Liu S, Zhang X. Pure red cell aplasia due to anti-erythropoietin antibodies or isoniazid? A case report from a 94-year-old man. Aging Clin Exp Res 2015; 27:561-2. [PMID: 25597021 DOI: 10.1007/s40520-014-0310-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Guang Yang
- Department of Geriatric Nephrology, Chinese PLA General Hospital, 28 Fuxing Rd, Beijing, 100853, China
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23
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Alves MT, Vilaça SS, Carvalho MDG, Fernandes AP, Dusse LMS, Gomes KB. Resistance of dialyzed patients to erythropoietin. Rev Bras Hematol Hemoter 2015; 37:190-7. [PMID: 26041422 PMCID: PMC4459468 DOI: 10.1016/j.bjhh.2015.02.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023] Open
Abstract
Resistance to recombinant human erythropoietin is a common condition in dialyzed patients with chronic kidney disease and is associated with more hospitalizations, increased mortality and frequent blood transfusions. The main cause of hyporesponsiveness to recombinant human erythropoietin in these patients is iron deficiency. However, a high proportion of patients does not respond to treatment, even to the use of intravenous iron, which indicates the presence of other important causes of resistance. In addition to the iron deficiency, the most common causes of resistance include inflammation, infection, malnutrition, inadequate dialysis, and hyperparathyroidism, although other factors may be associated. In the presence of adequate iron stores, other causes should be investigated and treated appropriately.
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Affiliation(s)
| | | | | | | | | | - Karina Braga Gomes
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
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24
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Kaye SW, Ossiboff RJ, Noonan B, Stokol T, Buckles E, Seimon TA, Morrisey J, de Matos R. Biliary Coccidiosis Associated With Immunosuppressive Treatment of Pure Red Cell Aplasia in an Adult Ferret (Mustela putorius furo). J Exot Pet Med 2015. [DOI: 10.1053/j.jepm.2015.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Iron as the key modulator of hepcidin expression in erythroid antibody-mediated hypoplasia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:421304. [PMID: 25580431 PMCID: PMC4281449 DOI: 10.1155/2014/421304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 10/12/2014] [Indexed: 01/01/2023]
Abstract
Erythroid hypoplasia (EH) is a rare complication associated with recombinant human erythropoietin (rHuEPO) therapies, due to development of anti-rHuEPO antibodies; however, the underlying mechanisms remain poorly clarified. Our aim was to manage a rat model of antibody-mediated EH induced by rHuEPO and study the impact on iron metabolism and erythropoiesis. Wistar rats treated during 9 weeks with a high rHuEPO dose (200 IU) developed EH, as shown by anemia, reduced erythroblasts, reticulocytopenia, and plasmatic anti-rHuEPO antibodies. Serum iron was increased and associated with mRNA overexpression of hepatic hepcidin and other iron regulatory mediators and downregulation of matriptase-2; overexpression of divalent metal transporter 1 and ferroportin was observed in duodenum and liver. Decreased EPO expression was observed in kidney and liver, while EPO receptor was overexpressed in liver. Endogenous EPO levels were normal, suggesting that anti-rHuEPO antibodies blunted EPO function. Our results suggest that anti-rHuEPO antibodies inhibit erythropoiesis causing anemia. This leads to a serum iron increase, which seems to stimulate hepcidin expression despite no evidence of inflammation, thus suggesting iron as the key modulator of hepcidin synthesis. These findings might contribute to improving new therapeutic strategies against rHuEPO resistance and/or development of antibody-mediated EH in patients under rHuEPO therapy.
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26
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Al-Issa K, Visconte V, Rogers HJ, Dembla V, Lichtin AE, Tiu RV. Cyclosporine dependent pure red cell aplasia: a case presentation. Blood Cells Mol Dis 2014; 54:281-3. [PMID: 25488615 DOI: 10.1016/j.bcmd.2014.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Karam Al-Issa
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Valeria Visconte
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Heesun J Rogers
- Department of Laboratory Medicine, Cleveland Clinic, OH, USA
| | - Vikas Dembla
- Overton Brooks VA Medical Center, Shreveport, LA, USA
| | - Alan E Lichtin
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ramon V Tiu
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
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27
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Parida PK, Shukla SN, Talati SS, Parikh SK. Acquired pure red cell aplasia in a patient of rheumatoid arthritis. Indian J Hematol Blood Transfus 2014; 30:255-7. [PMID: 25332592 DOI: 10.1007/s12288-014-0349-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/31/2014] [Indexed: 10/25/2022] Open
Abstract
Pure red cell aplasia (PRCA) is characterized as a normocytic anemia associated with reticulocytopenia and the absence of erythroblasts in the bone marrow. PRCA can be induced by various causes such as thymoma, connective tissue disease, viral infection, lymphoma, and adverse drug reactions. There have been only a few reports of PRCA associated with rheumatoid arthritis (RA). We report a 45 year old female presented with symptomatic anemia of several months duration on a background of long standing seropositive deforming RA. Bone marrow examination revealed marked suppression of erythroid precursors with normal myeloid and megakaryocytic series, thereby confirming PRCA. Anemia improved following therapy with prednisolone 1 mg/kg/day. This article also reviews the current status of therapy in acquired PRCA.
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Affiliation(s)
- Prasant Kumar Parida
- Department of Medical and Pediatric Oncology, Gujarat Cancer and Research Institute (GCRI), Asarwa, Ahmedabad, 380016 India
| | - Shilin N Shukla
- Department of Medical and Pediatric Oncology, Gujarat Cancer and Research Institute (GCRI), Asarwa, Ahmedabad, 380016 India
| | - Shailesh S Talati
- Department of Medical and Pediatric Oncology, Gujarat Cancer and Research Institute (GCRI), Asarwa, Ahmedabad, 380016 India
| | - Sonia K Parikh
- Department of Medical and Pediatric Oncology, Gujarat Cancer and Research Institute (GCRI), Asarwa, Ahmedabad, 380016 India
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28
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Cerchione C, Catalano L, Cerciello G, Avilia S, Picardi M, Risitano AM, Pisano I, Alfinito F, Pane F. Role of lenalidomide in the management of myelodysplastic syndromes with del(5q) associated with pure red cell aplasia (PRCA). Ann Hematol 2014; 94:531-4. [DOI: 10.1007/s00277-014-2192-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
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29
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Fujimi A, Kamihara Y, Kanisawa Y, Hashimoto A, Nakajima C, Hayasaka N, Uemura N, Okuda T, Minami S, Iyama S, Takada K, Sato T, Hara A, Iwata Y, Furuichi K, Wada T, Kato J. Anti-erythropoietin receptor antibody-associated pure red cell aplasia accompanied by Coombs-negative autoimmune hemolytic anemia in a patient with T cell/histiocyte-rich large B cell lymphoma. Int J Hematol 2014; 100:490-3. [PMID: 25096221 DOI: 10.1007/s12185-014-1652-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/20/2014] [Accepted: 07/22/2014] [Indexed: 01/19/2023]
Abstract
A 79-year-old female diagnosed with T cell/histiocyte-rich large B cell lymphoma in complete remission after six cycles of rituximab-combined chemotherapy developed severe anemia, reticulocytopenia, and bone marrow erythroid hypoplasia. She was diagnosed with pure red cell aplasia (PRCA) accompanied by Coombs-negative autoimmune hemolytic anemia evidenced by a lack of glycophorin-A-positive cells in the bone marrow, haptoglobin under the detection level, and a high titer of RBC-bound IgG. Anti-erythropoietin receptor (EPOR) antibody was detected in the serum, and oligoclonal α/β and γ/δ T cells were also detected in her peripheral blood by Southern blotting analysis. Parvovirus B19 DNA was not detected by PCR. Although the treatment with rituximab had limited efficacy (specifically, only for hemolysis), subsequent cyclosporine therapy led to prompt recovery of erythropoiesis with the disappearance of anti-EPOR antibody and oligoclonal T cells. This is the first case report of anti-EPOR antibody-associated PRCA in a patient with malignant lymphoma treated successfully with cyclosporine.
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MESH Headings
- Aged
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/immunology
- Antibodies, Monoclonal/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Female
- Fluorodeoxyglucose F18
- Histiocytes/pathology
- Humans
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Neoplasm Staging
- Positron-Emission Tomography
- Receptors, Erythropoietin/antagonists & inhibitors
- Red-Cell Aplasia, Pure/chemically induced
- Red-Cell Aplasia, Pure/complications
- Red-Cell Aplasia, Pure/drug therapy
- T-Lymphocytes/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- Akihito Fujimi
- Department of Hematology and Oncology, Oji General Hospital, 3-4-8 Wakakusa-Cho, Tomakomai, 053-8506, Japan,
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30
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Grimes CN, Fry MM. Nonregenerative anemia: mechanisms of decreased or ineffective erythropoiesis. Vet Pathol 2014; 52:298-311. [PMID: 24807888 DOI: 10.1177/0300985814529315] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In veterinary medicine, anemia without an appropriate compensatory hematopoietic response is termed nonregenerative. Nonregenerative anemia is a common clinical entity, occurring as a result of diminished or ineffective erythropoiesis in association with many types of pathology. This article reviews nonregenerative anemia in domestic animals, emphasizing mechanisms of disease, and also covers other conditions associated with nonregenerative anemia in people. Many aspects of nonregenerative anemia in animals are worthy of further investigation, from molecular mechanisms of disease to epidemiologic impacts.
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Affiliation(s)
- C N Grimes
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - M M Fry
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
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31
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Dolai TK, Dutta S, Mandal PK, Saha S, Bhattacharyya M. Lenalidomide-induced pure red cell aplasia. Turk J Haematol 2014; 31:99-100. [PMID: 24764740 PMCID: PMC3996643 DOI: 10.4274/tjh.2013.0207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/09/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Tuphan Kanti Dolai
- NRS Medical College and Hospital, Department of Hematology, Kolkata, India
| | - Shyamali Dutta
- NRS Medical College and Hospital, Department of Hematology, Kolkata, India
| | | | - Sandeep Saha
- NRS Medical College and Hospital, Department of Hematology, Kolkata, India
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32
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Varshney P, Verma V, Verma N, Gupta AK, Kumar Singhal M. An unusual case of post-renal transplant anemia induced by Parvovirus B19. INDIAN JOURNAL OF TRANSPLANTATION 2014. [DOI: 10.1016/j.ijt.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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33
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Pure red cell aplasia associated with autoimmune hepatitis successfully treated with cyclosporine A. Clin J Gastroenterol 2014; 7:74-8. [PMID: 24523831 PMCID: PMC3915077 DOI: 10.1007/s12328-013-0448-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 12/15/2013] [Indexed: 11/03/2022]
Abstract
A 47-year-old female with a 17-year history of autoimmune hepatitis had been treated with prednisolone, azathioprine, and ursodeoxycholic acid. Although her alanine aminotransferase level occasionally showed mild abnormality, the prednisolone dose could not be increased because she had developed cataract during the course of her illness. In May 2012, she developed severe normochromic normocytic anemia without hemorrhage, and azathioprine was discontinued because it was suspected of being the cause. However, anemia recurred frequently even after discontinuation, necessitating repeated blood transfusions. Bone marrow analysis revealed selective erythroblastopenia, thus leading to a diagnosis of pure red cell aplasia. Cyclosporine A was administered, which led to a dramatic recovery from anemia, and stabilized her alanine aminotransferase levels. Furthermore, the prednisolone dose could be gradually tapered. Pure red cell aplasia associated with autoimmune hepatitis is extremely rare. The present case shows that patients with autoimmune hepatitis refractory to the standard treatment regimen and those with concomitant pure red cell aplasia may be treated with cyclosporine A.
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34
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Iwadate H, Kobayashi H, Shio K, Noguchi E, Watanabe K, Sasajima T, Sekine H, Watanabe H, Ohira H, Obara K, Sato Y. A case of systemic lupus erythematosus complicated by pure red cell aplasia and idiopathic portal hypertension after thymectomy. Mod Rheumatol 2014. [DOI: 10.3109/s10165-006-0465-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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35
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Dharmshaktu P, Gupta N, Dhanwal DK. Successful treatment of acquired pure red cell aplasia with oral corticosteroids in a patient with B-cell CLL. BMJ Case Rep 2013; 2013:bcr2013201027. [PMID: 24234432 PMCID: PMC3830188 DOI: 10.1136/bcr-2013-201027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present the case of a 57-year-old male patient diagnosed with chronic lymphoid leukaemia (CLL) B-cell type along with moderate anaemia. On follow-up investigations the aetiology of anaemia turned out to be pure red cell aplasia (PRCA) on trephine bone biopsy with an elevated serum erythropoietin level. The patient received blood transfusion support. He showed remarkable improvement on oral corticosteroids (prednisolone 60 mg/daily dose) with no further requirement of blood transfusion over next 3 months. However, when the dose of steroid was tapered down to 10 mg/day, the anaemia reappeared. An increase in the dose of steroid brought the haemoglobin level back to normal. Anaemia in CLL can be due to many reasons, of which PRCA is an uncommon association occurring in only around 1% of patients with CLL and usually refractory to the conventional treatment with steroids. This PRCA secondary to CLL is considered to be immune in origin and a response to combination of immunosuppressive therapy such as steroids, cyclosporine, rituximab is anticipated. Our case responded completely to oral steroids alone.
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MESH Headings
- Administration, Oral
- Adrenal Cortex Hormones/administration & dosage
- Adrenal Cortex Hormones/therapeutic use
- Bone Marrow/pathology
- Diagnosis, Differential
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Male
- Middle Aged
- Prednisolone/administration & dosage
- Prednisolone/therapeutic use
- Red-Cell Aplasia, Pure/diagnosis
- Red-Cell Aplasia, Pure/drug therapy
- Red-Cell Aplasia, Pure/etiology
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36
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Deferasirox treatment improved hematopoiesis and led to complete remission in a patient with pure red cell aplasia. Int J Hematol 2013; 98:719-22. [DOI: 10.1007/s12185-013-1455-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 09/18/2013] [Accepted: 10/16/2013] [Indexed: 01/07/2023]
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37
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Imai T, Ishida H, Suzue K, Hirai M, Taniguchi T, Okada H, Suzuki T, Shimokawa C, Hisaeda H. CD8(+) T cell activation by murine erythroblasts infected with malaria parasites. Sci Rep 2013; 3:1572. [PMID: 23535896 PMCID: PMC3610137 DOI: 10.1038/srep01572] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 03/11/2013] [Indexed: 01/30/2023] Open
Abstract
Recent studies show that some human malaria parasite species Plasmodium falciparum and P.vivax parasitize erythroblasts; however, the biological and clinical significance of this is unclear. To investigate further, we generated a rodent malaria parasite (P. yoelii 17XNL) expressing GFP-ovalbumin (OVA). Its infectivity to erythroblasts was confirmed, and parasitized erythroblasts were capable of initiating malaria infections. Experiments showed that MHC class I molecules were highly expressed on parasitized erythroblasts. As CD8+ T cells recognize MHC class I and peptide complexes on target cells, and are involved in protection or pathology against malaria, we examined whether erythroblasts are targeted by CD8+ T cells. Purified non-parasitized erythroblasts pulsed with OVA peptides were recognized by OVA-specific CD8+ T cells. Crucially, parasitized erythroblasts isolated from GFP-OVA-, but not GFP- infected-mice, activated OT-I CD8+ T cells, indicating that CD8+ T cells recognize parasitized erythroblasts in an antigen-specific manner.
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Affiliation(s)
- Takashi Imai
- Department of Parasitology, Graduate School of Medicine, Gunma University, Gunma 371-8511, Japan
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Waldenström's macroglobulinaemia complicated by pure red cell aplasia: a case report. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:630-3. [PMID: 23736934 DOI: 10.2450/2013.0235-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 02/28/2013] [Indexed: 12/27/2022]
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D'Arena G, Guariglia R, La Rocca F, Trino S, Condelli V, De Martino L, De Feo V, Musto P. Autoimmune cytopenias in chronic lymphocytic leukemia. Clin Dev Immunol 2013; 2013:730131. [PMID: 23690826 PMCID: PMC3652131 DOI: 10.1155/2013/730131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/18/2013] [Accepted: 03/22/2013] [Indexed: 11/25/2022]
Abstract
The clinical course of chronic lymphocytic leukemia (CLL) may be complicated at any time by autoimmune phenomena.The most common ones are hematologic disorders, such as autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Pure red cell aplasia (PRCA) and autoimmune agranulocytosis (AG) are, indeed, more rarely seen. However, they are probably underestimated due to the possible misleading presence of cytopenias secondary to leukemic bone marrow involvement or to chemotherapy cytotoxicity. The source of autoantibodies is still uncertain, despite the most convincing data are in favor of the involvement of resting normal B-cells. In general, excluding the specific treatment of underlying CLL, the managementof these complications is not different from that of idiopathic autoimmune cytopenias or of those associated to other causes. Among different therapeutic approaches, monoclonal antibody rituximab, given alone or in combination, has shown to be very effective.
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MESH Headings
- Agranulocytosis/complications
- Agranulocytosis/drug therapy
- Agranulocytosis/immunology
- Agranulocytosis/pathology
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/immunology
- Anemia, Hemolytic, Autoimmune/pathology
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Autoantibodies/immunology
- Autoimmunity
- Humans
- Immunologic Factors/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Red-Cell Aplasia, Pure/complications
- Red-Cell Aplasia, Pure/drug therapy
- Red-Cell Aplasia, Pure/immunology
- Red-Cell Aplasia, Pure/pathology
- Rituximab
- Thrombocytopenia/complications
- Thrombocytopenia/drug therapy
- Thrombocytopenia/immunology
- Thrombocytopenia/pathology
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Affiliation(s)
- Giovanni D'Arena
- Onco-Hematology Department, IRCCS Centro di Riferimento Oncologico della Basilicata, 85028 Rionero in Vulture, Italy.
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Abstract
INTRODUCTION Erythropoiesis-stimulating agents (ESAs) are the mainstay of treatment in anemic chronic kidney disease (CKD) patients. A tailored ESA therapy should combine maximal efficacy and safety with greatest convenience in dosing. Peginesatide, recently approved in the US for once-monthly dosing in adult patients on dialysis, is a promising novel PEGylated erythropoietin-mimetic peptide for the treatment of renal disease-induced anemia. AREAS COVERED Published animal and human studies that evaluated the pharmacodynamics, pharmacokinetics, clinical efficacy and safety of peginesatide were critically analyzed. EXPERT OPINION Peginesatide has a well-studied pharmacological and immunological profile, and latest published data favor the use of peginesatide in place of epoetin in dialysis patients. A more detailed evaluation of its safety profile particularly in trials with CKD patients not requiring dialysis is urgently needed, as peginesatide could be a perfect treatment solution for these patients. In addition, clinical long-term data and results from supplemental studies, e.g., with the PEGylated continuous erythropoietin receptor activator as comparator, should briefly follow. The fate of peginesatide on the highly competitive ESA market is currently not predictable and depends on safety and efficacy results of upcoming trials as well as finally on market and price policy.
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Affiliation(s)
- Holger Schmid
- University of Munich, Department of Internal Medicine, Munich, D-80336, Germany.
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Soma P, Ellemdin S, Mashoeshoe K. The differential diagnosis of HIV related anaemia should include pure red cell aplasia. HIV & AIDS REVIEW 2013. [DOI: 10.1016/j.hivar.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Ito S, Ikuta K, Yamamoto M, Okamura N, Ichiki K, Sugiyama J, Shindo M, Torimoto Y, Kohgo Y. [Case report: a case of pure red cell aplasia associated with pregnancy]. ACTA ACUST UNITED AC 2012; 101:2042-4. [PMID: 22897008 DOI: 10.2169/naika.101.2042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Satoshi Ito
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
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Yoon YK, Park DW, Sohn JW, Kim MJ, Kim I, Nam MH. Corticosteroid treatment of pure red cell aplasia in a patient with hepatitis A. Acta Haematol 2012; 128:60-3. [PMID: 22627171 DOI: 10.1159/000337342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 02/17/2012] [Indexed: 01/10/2023]
Abstract
Secondary pure red cell aplasia (PRCA), as an extrahepatic manifestation of hepatitis A virus infection, has been reported on rare occasions. We report herein an unusual case of hepatitis A complicated by PRCA. In addition, we reviewed nine cases reported in the English literature. Our case of nonfulminant hepatitis A complicated by PRCA and hemolytic anemia was successfully treated with initial transfusion and corticosteroid therapy for 18 weeks. The patient's hematologic abnormalities and liver function tests re-normalized completely. We review clinical features and effective therapeutic strategies for this disease entity.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Vlachaki E, Diamantidis MD, Klonizakis P, Haralambidou-Vranitsa S, Ioannidou-Papagiannaki E, Klonizakis I. Pure red cell aplasia and lymphoproliferative disorders: an infrequent association. ScientificWorldJournal 2012; 2012:475313. [PMID: 22593689 PMCID: PMC3349208 DOI: 10.1100/2012/475313] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 10/26/2011] [Indexed: 11/17/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a rare bone marrow failure syndrome defined by a progressive normocytic anaemia and reticulocytopenia without leukocytopenia and thrombocytopenia. Secondary PRCA can be associated with various haematological disorders, such as chronic lymphocytic leukaemia (CLL) or non-Hodgkin lymphoma (NHL). The aim of the present review is to investigate the infrequent association between PRCA and lymphoproliferative disorders. PRCA might precede the appearance of lymphoma, may present simultaneously with the lymphoid neoplastic disease, or might appear following the lymphomatic disorder. Possible pathophysiological molecular mechanisms to explain the rare association between PRCA and lymphoproliferative disorders are reported. Most cases of PRCA are presumed to be autoimmune mediated by antibodies against either erythroblasts or erythropoietin, by T-cells secreting factors selectively inhibiting erythroid colonies in the bone marrow or by NK cells directly lysing erythroblasts. Finally, focus is given to the therapeutical approach, as several treatment regimens have failed for PRCA. Immunosuppressive therapy and/or chemotherapy are effective for improving anaemia in the majority of patients with lymphoma-associated PRCA. Further investigation is required to define the pathophysiology of PRCA at a molecular level and to provide convincing evidence why it might appear as a rare complication of lymphoproliferative disorders.
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Affiliation(s)
- Efthymia Vlachaki
- Department of Haematology, Second Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, 546 42, Thessaloniki, Greece
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46
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Jung SH, Ahn JS, Yang DH, Chul Park H, Bae SY, Kim YK, Kim HJ, Lee JJ. Successful Treatment of Pure Red Cell Aplasia with Rituximab in Patients after ABO-Compatible Allogeneic Hematopoietic Stem Cell Transplantation. Case Rep Oncol 2012; 5:110-3. [PMID: 22539923 PMCID: PMC3337734 DOI: 10.1159/000337022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pure red cell aplasia (PRCA) following allogeneic hematopoietic stem cell transplantation (HSCT) has been mostly reported in situations involving major ABO incompatibility between donor and recipient. Conventional treatments such as plasma exchange, erythropoietin, and steroid are often unsatisfactory. Rituximab has been reported to be highly effective for PRCA following major ABO-incompatible allogeneic HSCT. A 49-year-old woman with PRCA following ABO-matched allogeneic HSCT for acute lymphoblastic leukemia, refractory to erythropoietin treatment, received 4 doses of rituximab 375 mg/m2 weekly. After the 3rd dose of rituximab, she exhibited a striking rise in her reticulocyte count with an increase in her hemoglobin level. To our knowledge, this is the first case of PRCA following major ABO-compatible allogeneic HSCT resolving completely after rituximab treatment.
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Affiliation(s)
- Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
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Nitta H, Harada Y, Hyodo H, Kimura A, Harada H. Expansion of CD8+/perforin+T-cells predicts response to ciclosporin A therapy in patients with erythroid hypoplasia/aplasia. Br J Haematol 2012; 157:641-5. [DOI: 10.1111/j.1365-2141.2012.09057.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hideaki Nitta
- Division of Clinical Research; Department of Haematology and Oncology; Research Institute for Radiation Biology and Medicine; Hiroshima University; Hiroshima
| | - Yuka Harada
- Division of Radiation Information Registry; Research Institute for Radiation Biology and Medicine; Hiroshima University; Hiroshima; Japan
| | - Hideo Hyodo
- Division of Clinical Research; Department of Haematology and Oncology; Research Institute for Radiation Biology and Medicine; Hiroshima University; Hiroshima
| | - Akiro Kimura
- Division of Clinical Research; Department of Haematology and Oncology; Research Institute for Radiation Biology and Medicine; Hiroshima University; Hiroshima
| | - Hironori Harada
- Division of Clinical Research; Department of Haematology and Oncology; Research Institute for Radiation Biology and Medicine; Hiroshima University; Hiroshima
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Viviano KR, Webb JL. Clinical Use of Cyclosporine as an Adjunctive Therapy in the Management of Feline Idiopathic Pure Red Cell Aplasia. J Feline Med Surg 2011; 13:885-95. [DOI: 10.1016/j.jfms.2011.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2011] [Indexed: 01/17/2023]
Abstract
The clinical use of cyclosporine is described in a group of client-owned cats diagnosed with idiopathic pure red cell aplasia (PRCA). All 10 cats were treated with combinations of glucocorticoids and cyclosporine. Of the 10 cats, the eight for which follow-up data was available achieved and maintained remission for a median of 31 and 406 days, respectively. Therapy was reduced or discontinued in 7/8 cats; 2/7 maintained remission off therapy and 5/7 cats relapsed. Remission was reinduced in four cats, with 3/4 cats maintained long-term on low dose therapy. Adverse effects associated with cyclosporine therapy were responsive to dose reduction or drug withdrawal. Feline idiopathic PRCA was responsive to combination immunosuppressive therapy with glucocorticoids and cyclosporine. Relapse was common, particularly after drug discontinuation; therefore, most cats required maintenance long-term low dose therapy.
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Affiliation(s)
- Katrina R Viviano
- Department of Medical Sciences, University of Wisconsin-Madison, School of Veterinary Medicine, 2015 Linden Dr, Madison, WI 53711, USA
| | - Julie L Webb
- Department of Pathobiological Sciences, University of Wisconsin-Madison, School of Veterinary Medicine, Madison, WI 53711, USA
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49
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Lee TH, Oh SJ, Hong S, Lee KB, Park H, Woo HY. Pure red cell aplasia caused by acute hepatitis a. Chonnam Med J 2011; 47:51-3. [PMID: 22111059 PMCID: PMC3214852 DOI: 10.4068/cmj.2011.47.1.51] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 03/09/2011] [Indexed: 11/16/2022] Open
Abstract
Pure red cell aplasia is characterized as a normocytic anemia associated with reticulocytopenia and the absence of erythroblasts in the bone marrow. Pure red cell aplasia can be induced by various causes such as thymoma, connective tissue disease, viral infection, lymphoma, and adverse drug reactions. There have been only a few reports of pure red cell aplasia associated with acute viral hepatitis A. In Korea, no case of pure red cell aplasia caused by acute hepatitis A has yet been reported. We recently experienced a case of acute viral hepatitis A complicated by pure red cell aplasia. The patient was successfully treated with corticosteroids. Here we report this case and review the literature.
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Affiliation(s)
- Tae Heon Lee
- Department of Internal Medicine, Kangbuk Samsung Medical Center, Sunggyunkwan University College of Medicine, Seoul, Korea
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50
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Aranda C, Pérez M, Herreros B, Peñalver FJ. [Pure red cell aplasia and Hashimoto's thyroiditis: a rare association]. Med Clin (Barc) 2011; 137:476-7. [PMID: 21470643 DOI: 10.1016/j.medcli.2010.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 12/15/2010] [Accepted: 12/16/2010] [Indexed: 10/17/2022]
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