Four cases of pure red cell aplasia secondary to epoetin β, with strong temporal relationships

We describe two pairs of patients with PRCA associated with epoetin-β. The two recent cases (2002) presented a typical profile, with complete or partial response to corticosteroids. Two historical cases identified by anecdote, and then by discordant low reticulocyte responses, had been diagnosed presviously as due to sepsis-induced epoetin resistance. They showed a complete clinical picture, where both suffered a sudden fall in Hb consistent with aplasia (one with atypical bone marrow findings), and appear to have recovered under different treatment regimes. One patient was re-exposed to epoetin-β without recurrent clinical disease. Remarkably, the cases were temporally related in 1998 and 2002, but physical association was not apparent in the historical pair. Mishandling of the epoetin product or a shared viral aetiology are possibilities that may be suspected. © ERA-EDTA 2004; all rights reserved.