The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Erythropoietin Antibody-Positive Pure Red Cell Aplasia Diagnosed after Surgical Intervention for Malignant Gastric Ulcer Bleeding

위암 출혈로 오인된 에리트로포이에틴 항체 양성 순수 적혈구 무형성증

  • Yang, Hae Kyung (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Kyeong Soo (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Kim, In Ho (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Oh, Hyun Jin (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Hae Lim (Department of Internal Medicine, The Catholic University of Korea College of Medicine) ;
  • Lee, Kwan Hyun (Department of Internal Medicine, Cheongju St. Mary's Hospital) ;
  • Hwang, Dae Yeon (Department of Internal Medicine, Cheongju St. Mary's Hospital)
  • 양혜경 (가톨릭대학교 의과대학 내과학교실) ;
  • 이경수 (가톨릭대학교 의과대학 내과학교실) ;
  • 김인호 (가톨릭대학교 의과대학 내과학교실) ;
  • 오현진 (가톨릭대학교 의과대학 내과학교실) ;
  • 이해림 (가톨릭대학교 의과대학 내과학교실) ;
  • 이관현 (청주성모병원 내과) ;
  • 황대연 (청주성모병원 내과)
  • Received : 2012.06.01
  • Accepted : 2012.08.27
  • Published : 2013.03.01
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Abstract

Rarely, patients on erythropoietin stimulating agent (ESA) therapy develop antibodies that neutralize both ESA and endogenous erythropoietin, resulting in antibody-mediated pure red cell aplasia (PRCA). The sudden development of severe transfusion-dependent anemia requires rapid recognition, the evaluation of PRCA, and prompt intervention after differentiating other causes of anemia, such as iron deficiency, occult bleeding, and infection. Here, we report the case of a 67-year-old male undergoing hemodialysis who presented with the anemia of chronic blood loss from a malignant gastric ulcer. Even after surgical intervention for stomach cancer and increasing the erythropoietin dosage, the anemia was not correctable and required monthly packed red blood cell transfusions. Further evaluation revealed positive erythropoietin antibody, and a bone marrow biopsy showed no red blood cell precursors, supporting the diagnosis of PRCA.

혈액투석 환자에서 빈혈의 주요 원인은 에리트로포이에틴 생성 장애이며 이에 대한 치료로 재조합 인 에리트로포이에틴이 널리 사용되고 있다. 이러한 치료에 저항성을 보이는 경우 만성 출혈 등에 의한 철분 부족을 우선적으로 고려해야 하지만 원인질환을 교정한 후에도 적혈구 수혈이 필요할 정도로 빈혈이 지속된다면 에리트로포이에틴 항체 형성에 의한 순수 적혈구 무형성증을 감별하기 위한 에리트로포이에틴에 항체 및 골수 조직검사 등이 적극적으로 이루어져야 할 것으로 보인다.

Keywords

References

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