Pure red-cell aplasia in a peritoneal dialysis patient with HCV-related cryoglobulinemia in the absence of neutralizing antierythropoietin antibodies.

Pure red-cell aplasia (PRCA) in recombinant human erythropoietin (rHuEpo) treated patients is a matter of growing concern. In most cases, neutralizing anti-EPO antibodies have been detected in patient serum and held responsible for the development of PRCA. We describe a 68-year-old white woman suffering from HCV-related cryoglobulinemia and chronic kidney disease on renal replacement therapy with peritoneal dialysis. Five months after the introduction of epoetin-b therapy she developed a PRCA, as shown by the bone marrow aspirate. Cryocrit rose from 5% to 15% at this time, reticulocyte count fell, while white blood cells and platelets remained within normal values. Epoetin-b therapy was discontinued and steroid treatment was started. The test for anti-erythropoietin antibodies was negative. Hemoglobin and reticulocytes progressively rose and steroid therapy was tapered and eventually stopped, when the cryocrit was 3%. We propose that a relapse in the HCV-related cryoglobulinemia might be held responsible for the erythropoietic marrow failure.