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




Rituximab therapy for pure red cell aplasia due to anti-epoetin antibodies in a woman treated with epoetin-alfa: a case report - Download this document for free, or read online. Document in PDF available to download.

Journal of Medical Case Reports

, 3:7335

First Online: 06 July 2009Received: 22 April 2008Accepted: 22 January 2009DOI: 10.4076-1752-1947-3-7335

Cite this article as: Behler, C.M., Terrault, N.A., Etzell, J.E. et al. J Med Case Reports 2009 3: 7335. doi:10.4076-1752-1947-3-7335

Abstract

IntroductionPure 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 presentationThis 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.

ConclusionThe 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.

AbbreviationsCKDchronic kidney disease

G-CSFgranulocyte-colony stimulating factor

HCVhepatitis C virus

IVIGintravenous gammaglobulin

LDHlactate dehydrogenase

PRBCpacked red blood cell

PRCApure red cell aplasia

TSHthyroid stimulating hormone.

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Author: Caroline M Behler - Norah A Terrault - Joan E Etzell - Lloyd E Damon

Source: https://link.springer.com/







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