Macdougall Iain C
Department of Renal Medicine, King's College Hospital, London, UK.
Curr Opin Nephrol Hypertens. 2007 Nov;16(6):585-8. doi: 10.1097/MNH.0b013e3282f0c4bf.
Antibody-mediated pure red cell aplasia is now recognized as a rare complication of erythropoiesis-stimulating agent therapy. The incidence of this adverse effect peaked in 2002, but new cases still appear sporadically. The aim of this review is to discuss the latest opinions regarding the detection and management of this condition.
The diagnosis of classical erythropoiesis-stimulating agent induced pure red cell aplasia is made by a constellation of clinical features, including severe transfusion-dependent anaemia, reticulocytopenia, low or absent erythroblasts in the bone marrow, and the presence of circulating antierythropoietin antibodies. Recently, some cases have been reported in which the bone marrow findings show red cell hypoplasia rather than aplasia; this may represent earlier presentations of the same condition.
Management of pure red cell aplasia as a complication of erythropoiesis-stimulating agent therapy consists of stopping the drug and implementing an immunosuppressive regimen to reduce or abolish erythropoietin antibody production. A recent animal study suggested that a possible alternative strategy may be to administer a novel peptide-based erythropoietin receptor agonist called Hematide that does not cross react with antierythropoietin antibodies, and will allow ongoing stimulation of erythropoiesis; this is the subject of a current clinical trial.
抗体介导的纯红细胞再生障碍目前被认为是促红细胞生成素治疗的一种罕见并发症。这种不良反应的发生率在2002年达到峰值，但新病例仍时有出现。本综述旨在探讨有关这种情况的检测和管理的最新观点。
经典的促红细胞生成素诱导的纯红细胞再生障碍的诊断是基于一系列临床特征，包括严重的输血依赖型贫血、网织红细胞减少、骨髓中幼红细胞数量少或缺乏，以及循环中抗促红细胞生成素抗体的存在。最近，有一些病例报告显示骨髓检查结果为红细胞发育不全而非再生障碍；这可能代表了同一病症的早期表现。
作为促红细胞生成素治疗并发症的纯红细胞再生障碍的管理包括停用药物并实施免疫抑制方案以减少或消除促红细胞生成素抗体的产生。最近的一项动物研究表明，一种可能的替代策略可能是给予一种名为Hematide的新型基于肽的促红细胞生成素受体激动剂，它不会与抗促红细胞生成素抗体发生交叉反应，并能持续刺激红细胞生成；这是当前一项临床试验的主题。
