Pure Red Cell Anemia a Complication of Recombinant Erythropoietin
- سال انتشار: 1397
- محل انتشار: ششمین کنگره بین المللی انجمن نفرولوژی کودکان ایران
- کد COI اختصاصی: CNAMED06_073
- زبان مقاله: فارسی
- تعداد مشاهده: 466
نویسندگان
Iran University of Medical Sciences, Tehran, Iran
Iran University of Medical Sciences, Tehran, Iran
Iran University of Medical Sciences, Tehran, Iran
چکیده
Recombinant erythropoietin (EPO) is used to treat anemia in chronic kidney disease (CKD) to avoid multiple transfusions. Pure red cell aplasia (PRCA) is rare serious complication of EPO. The incidence increased considerably in 1998 decreased sharply since 2003.Hereby we presented a 5 -year old boy admitted with severe anemia. The underlying disease was nephritic syndrome with a progressive course that led to end stage renal disease. He went on CAPD with 600/m2 three four times per day of dextrose 1.45% fluid and 100 ml extraneal at night since 2016. The peritoneal clearance and PET were checked every three months. The baseline hemoglobin (Hb) was 8.9 g/d and EPO-alpha ( PD-poetin) started with dosage of 300 U/kg/week. The Hb gradually increased to 11.6 g/dl and was persistently stable. After being 19 months on CAPD, the Hb declined to 6 g/dl, enalparil discontinued, EPO and PD dosages increased. Subsequently, the patient admitted with malaise and poor feeding the next month, Hb was 3 g/dl. The trough evaluation for the cause of severe anemia was done. Bone marrow aspiration revealed pure red cell aplasia .With diagnosis of EPO induced PRCA, EPO stopped, transfusion was started, prednisolon 2mg/kg/day and IVIG 400mg/m2 and then every two weeks while prednisolon tapered off. The Hb improved to 6 g/dl and the need to transfusion declined. He prepared for renal transplantation one month later. Kidney transplantation was unsuccessful and he passed away by massive hemorrhage and cardiac arrest.Conclusion: In the case of severe anemia in CKD child full evaluation for detecting underlying etiology is importantکلیدواژه ها
Pure red cell aplasia, Anti-erythropoietin antibodies, Immunosuppressant therapy, Dialysis, Erythropoietinمقالات مرتبط جدید
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