Rational management approach to pure red cell aplasia

Acquired pure red cell aplasia in a patient with ankylosing spondylitis- a case report and literature review

RATIONALE

Acquired pure red cell aplasia (PRCA) can be a secondary response to some autoimmune disorders. However, there is no data about the possibility of acquired PRCA being a secondary complication to ankylosing spondylitis (AS).

PATIENT CONCERNS

A 42-year-old male who had a history of AS for 14 years. He got serious anemia 17 months ago. Bone marrow smear indicated PRCA.

DIAGNOSE

He was diagnosed with acquired PRCA secondary to AS.

INTERVENTION

The combination treatment of immunosuppressants with hematopoiesis stimuli was successful.

OUTCOMES

The patient recovered from PRCA, and showed improvement in his AS.

LESSONS

Acquired PRCA can be secondary to AS. Cyclosporine is effective in controlling AS arthritis syndrome and in addition to immunosuppressants, promotion of erythroid hematopoiesis is equally important.

Occurrence of acute pulmonary embolism induced by recombinant erythropoietin during treatment of pure red cell aplasia associated with thymoma: A case report

RATIONALE

Thymoma is a type of rare tumor in the thymus gland, and among patients with thymoma, less than 10% will develop pure red cell aplasia (PRCA), whereas less than 5% of patients with PRCA have a thymoma. The optimal approach for PRCA in thymoma is immunosuppressive therapy, such as steroids, cyclosporine, and human antithymocyte globulin.

PATIENT CONCERNS

A sixty-one-year-old male was diagnosed with thymoma with PRCA after he complained fatigue, tinnitus, and weakness for 1 month, he received therapy with recombinant erythropoietin (rhEPO) for 1 month after the tumor was totally resected and readmitted with pulmonary embolism and received anticoagulation therapy with enoxaparin for 3 months.

DIAGNOSES

Thymoma, pure red cell aplasia, pulmonary embolism.

INTERVENTION

He received cyclosporine A, prednisone and rhEPO treatment. Two months after the thymectomy and postoperative radiation, he was readmitted with pulmonary embolism.

OUTCOMES

Thymoma and pulmonary embolism become complete response (CR), PRCA become partial response (PR).

LESSONS

Clinicians should be alert to the possibility of the increased risk of thrombosis induced by rhEPO when it used to treat PRCA associated with thymoma. If other medication is effective for managing PRCA, rhEPO should be avoided.