Antibodies against human recombinant erythropoietin: an unusual cause of erythropoietin resistance
Virón, B.éa.; Kolta, A.; Kiladjian, J.J.; Mignon, F.; Mayeux, P.; Casadevall, N.
Nephrologie 23(1): 19-22
2002
ISSN/ISBN: 0250-4960 PMID: 11887573 Document Number: 549840
In a 70 year old man with primary glomerulonephritis, severe anemia occurred after 4 years on hemodialysis and rHu-EPO. The usual mechanisms of EPO-resistance were excluded. A bone marrow sample showed red all aplasia. No circulating EPO could be detected; the serum inhibited the growth of erythroid precursors in bone marrow cultures. Immunoprecipitation identified an IgG anti-EPO, still active against deglycosylated EPO, i.e. directed against the peptidic matrix. Its high neutralising capacity and the absence of any immune abnormality rule out an auto-antibody. Anti-rHu EPO immunisation is a very rare occurrence, made severe by transfusion-dependence and the risk of hemosiderosis. An immuno-modulating treatment can therefore be justified.