Another cause of anaemia

Sir, Renal impairment is commonly associated with normocytic anaemia, due to relative deficiency of erythropoietin, and it is now standard practice to treat this with recombinant human erythropoietin (r-HuEPO) once other causes of anaemia have been excluded. Recurrent anaemia in this setting may be due to occult gastrointestinal blood loss, and this is the most common cause of anaemia, but pure red cell aplasia (PRCA) secondary to an antibody to human recombinant erythropoietin also needs to be considered. We present such a case. An 80-year-old man, with a 19-year history of non-insulin-dependent diabetes mellitus complicated by diabetic retinopathy, diabetic nephropathy, obesity and congestive heart failure, was admitted to our hospital with lethargy and haemoglobin (Hb) of 6.7 g/dl. His red cell indices (MCV 92.7 fl, MCH 33.7 pg, MCHC 35.8 g/l) and haematinics (B12 673 ng/l, folate 6.5 ng/ml) were within the normal range. White cell count was 4.3 × 109/l and platelets were 64 × 10 …