Occasionally a patient treated with epoetin may develop pure red cell aplasia. Many of the patients have been on hemodialysis.


Clinical features:

(1) history of epoetin therapy

(2) severe anemia

(3) low reticulocyte count

(4) absence of erythroblasts on an adequate bone marrow examination

(5) failure to respond to erythropoietin administration

(6) presence of neutralizing antibodies against erythropoietin


Risk factors:

(1) formulation without human serum albumin

(2) subcutaneous administration of the epoetin

(3) prefilled syringes of epoetin with uncoated rubber stoppers


Risk reduction:

(1) formulating the epoetin with human serum albumin

(2) intravenous administration

(3) Teflon coating of rubber stoppers in prefilled syringes containing epoetin


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