Behler Caroline M, Terrault Norah A, Etzell Joan E, Damon Lloyd E
J Med Case Rep. 2009 Jul 6;3:7335. doi: 10.4076/1752-1947-3-7335.
Pure 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.
This 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.
The 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.
抗促红细胞生成素抗体导致的纯红细胞再生障碍是慢性肾脏病贫血促红细胞生成素治疗已知的并发症。此前，这种疾病在慢性丙型肝炎病毒感染治疗背景下尚未得到充分描述。虽然抗促红细胞生成素抗体所致纯红细胞再生障碍的治疗通常采用免疫抑制疗法，如钙调神经磷酸酶抑制，但这种治疗在慢性丙型肝炎病毒感染中的安全性尚不清楚。迄今为止，关于利妥昔单抗治疗抗促红细胞生成素抗体所致纯红细胞再生障碍的疗效鲜有报道。
本报告描述了一名65岁的亚裔美国女性，在利巴韦林和聚乙二醇干扰素治疗慢性丙型肝炎病毒感染期间接受促红细胞生成素α治疗后，因高滴度中和性抗促红细胞生成素抗体而发生纯红细胞再生障碍。我们描述了她使用利妥昔单抗治疗的结果。网织红细胞计数增加，抗促红细胞生成素抗体滴度降低，体外中和活性丧失，导致输血次数减少，贫血最终得到缓解，且丙型肝炎病毒未再激活。
在接受慢性丙型肝炎病毒感染治疗且在使用促红细胞生成素或达贝泊汀后发生严重贫血的患者中，应考虑抗促红细胞生成素抗体所致纯红细胞再生障碍的诊断。虽然目前利妥昔单抗用于该治疗属于超说明书用药，但对于抗促红细胞生成素抗体所致纯红细胞再生障碍患者而言，它是一种治疗选择。
