Response to cyclosporine A in a patient with pure red cell aplasia due to antierythropoietin-α antibodies

Reported cases of pure red cell aplasia (PRCA) from the administration of erythropoietin (EPO)-α molecule in the United States are rare, and the optimal treatment is still unknown. We present a patient with end-stage renal disease (ESRD) who became hyporesponsive and later unresponsive to EPO-α treatment a few months after initiation of hemodialysis. A comprehensive anemia examination was negative while the patient became transfusion dependent. The diagnosis of EPO-α-induced PRCA was confirmed by bone marrow biopsy, by undetectable serum EPO levels following the administration of a large dose of EPO-α, and by documenting the presence of EPO-neutralizing antibodies. Administration of cyclosporine A in addition to prednisone enabled the patient to become transfusion and EPO independent. This case further documents the possible occurrence of PRCA with EPO-α administration in the United States and reaffirms the potential beneficial effect of cyclosporine A.