Department of Internal Medicine, Ilsan Hospital, NHIC, Goyang, Republic of Korea.
Int Immunopharmacol. 2011 Dec;11(12):2237-41. doi: 10.1016/j.intimp.2011.10.014. Epub 2011 Oct 31.
Recombinant human erythropoietin (rhEPO) has been successfully used for correcting renal anemia. However, recent studies have raised some concerns about the safety of rhEPO treatment due to its immunogenic side effect - pure red cell aplasia (PRCA). We now report a case of development of anti-EPO neutralizing antibodies (Abs) implicated in thrombocytopenia as well as erythrocytopenia. A 35-year-old man had a history of administering rhEPO (epoetin alfa, epoetin beta and darbepoetin alfa) for 2years to treat renal anemia. The hematological parameters were collected. Anti-EPO, anti-platelet, and anti-thrombopoietin (TPO) Ab assays were performed to test the presence of autoreactive Abs. After performing antibody assays due to severe resistance to rhEPO treatment, a high titer of anti-EPO neutralizing Abs was detected. However, unexpectedly, this patient also showed thrombocytopenia rather than PRCA. We investigated the cause of the marked thrombocytopenia and found anti-TPO Abs in patient serum. To our best knowledge, this is the first report of the development of anti-TPO Abs during rhEPO treatment for anemia.
重组人红细胞生成素（rhEPO）已成功用于纠正肾性贫血。然而，最近的研究对 rhEPO 治疗的安全性提出了一些担忧，因为它具有免疫原性副作用 - 纯红细胞再生障碍（PRCA）。我们现在报告一例因血小板减少症和红细胞减少症而发展为抗 EPO 中和抗体（Abs）的病例。一名 35 岁男性因治疗肾性贫血而接受 rhEPO（促红素 alfa、促红素 beta 和达贝泊汀 alfa）治疗 2 年。收集了血液学参数。进行了抗 EPO、抗血小板和抗血小板生成素（TPO）Ab 检测，以检测自身反应性 Abs 的存在。由于对 rhEPO 治疗严重耐药而进行抗体检测后，检测到高滴度的抗 EPO 中和 Abs。然而，出乎意料的是，该患者还出现了血小板减少症而不是 PRCA。我们研究了导致血小板减少症的原因，并在患者血清中发现了抗 TPO Abs。据我们所知，这是首例在贫血接受 rhEPO 治疗期间发生抗 TPO Abs 的报告。
