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NDT Plus Advance Access originally published online on June 10, 2008
NDT Plus 2008 1(4):230-232; doi:10.1093/ndtplus/sfn064
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Antibody-mediated pure red cell aplasia (PRCA) on switching from darbepoetin alfa to epoetin beta: what are the implications?

José Assunção and José Vinhas

Kidney Centre, Fresenius Medical Care, Setúbal, Portugal

Correspondence: José Vinhas, Kidney Centre, Fresenius Medical Care, Estrada de Baixa de Palmela, Lote 1, 2900 Setúbal, Portugal. Tel: +351-265-541-840; Fax: +351-265-541-859; E-mail: j.vinhas{at}mail.telepac.pt


  Abstract

We report the development of antibody-mediated pure red cell aplasia (PRCA) in a 63-year-old man with end-stage renal disease following a switch from darbepoetin alfa to epoetin beta. Haemoglobin levels began to decrease 6 months after the switch. Increasing the epoetin beta dose produced no response and regular blood transfusions were required; PRCA was confirmed and epoetin beta was discontinued. The patient responded positively to immunosuppression; after 2 months on prednisone and cyclophosphamide, haemoglobin levels stabilized and no further transfusions were required. This case highlights the difficulty in establishing a cause-effect relationship where more than one erythropoiesis-stimulating agent is involved.

Key Words: darbepoetin alfa • epoetin beta • erythropoiesis-stimulating agents • pure red cell aplasia

Received for publication May 7, 2008. Accepted for publication May 9, 2008.


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