Characteristic Changes in Anti-erythropoietin Antibodies in a Peritoneal Dialysis Patient Who Developed Pure Red Cell Aplasia

Abstract

Although cases of anti-erythropoietin (anti-EPO) antibody-induced pure red cell aplasia (PRCA) have been reported since 1998, the role of anti-EPO antibodies in the development of PRCA is controversial, with many conflicting opinions. Here, we present a patient who had serial serum anti-EPO antibody levels measured both before and after the development of PRCA to observe the relationship between serial changes in anti-EPO antibody and hemoglobin levels. Enzyme-linked immunosorbent assays were used for the detection of anti-EPO antibodies. The patient's serum anti-EPO antibody levels showed a characteristic change over time: negative before the development of PRCA, strongly positive when PRCA was diagnosed, decreasing after receiving prednisone, and eventually became negative. More importantly, an inversely close association between changes in serum anti-EPO antibody and hemoglobin levels was shown. The characteristic changes in this case indicate that anti-EPO antibody might have a role in the development of PRCA, and monitoring the titer of anti-EPO antibody may be of great value in the diagnosis and treatment of PRCA.