Pure red cell aplasia in patients treated with recombinant erythropoietin for anemia due to chronic renal disease

: It has been reported in the Western literature that patients with chronic renal disease have developed anti-erythropoietin (EPO) antibody-related pure red cell aplasia (PRCA). To investigate the incidence of anti-EPO antibody-related PRCA in Japan, we designed a questionnaire survey based on previous reports of patients who had PRCA during treatment with EPO. Thirteen of 17 patients were evaluated in this study. In all 13 patients, EPO delivery was via injection, 9 subcutaneously, 2 intravenously and 2 with a combination of the 2 methods. Three of 4 patients treated with subcutaneous EPO administration were positive for anti-EPO antibodies, but all patients treated by intravenous injection were negative. The EPO was stopped in 8 patients after the onset of PRCA, and immunosuppressive therapy with prednisolone and/or cyclosporine was administered in 12 patients. An improvement in PRCA was obtained in 12 patients. It was suspected that previous reports in Japan may have included both anti-EPO antibody-associated PRCA and incidental cases. Furthermore, subcutaneous administration of EPO may effect the production of anti-EPO antibodies.