This is a very rare condition and usually affects adults. Pure red cell aplasia developed in a patient with small cell lung cancer who was also taking sustainedrelease procainamide. Cureus isoniazid induced pure red blood cell aplasia. The association of pure red cell aplasia prca with thymoma1 is well known. Apr 21, 2016 pure red cell aplasia prca is a rare condition that affects the bone marrow. Pure red cell aplasia prca is a syndrome defined by a normocytic normochromic anemia with severe reticulocytopenia and marked reduction or absence of. The disease also may be associated with a variety of other conditions, including paraproteinemia. Pure redcell aplasia prca is a rare hematologic disease characterized by anemia, reticulocytopenia, and absence of bone marrow erythroid precursors.
The condition may be caused by some virus infections, some drugs, cancers, rheumatoid arthritis and systemic lupus erythematosus. Durham, in pathologic basis of veterinary disease sixth edition, 2017. Pure red cell aplasia prca is a rare syndrome that only affects the erythroid. Further evaluation for the cause of anaemia revealed that the patient had pure red cell aplasia prca.
Upon evaluating the patient, she was found to have myasthenia gravis mg with anaemia and hypothyroidism. Acquired pure red cell aplasia is a rare bone marrow disorder characterized by an isolated decline of red blood cells erythrocytes produced by the bone marrow. The condition has been first described by paul kaznelson in 1922. Pure red blood cell aplasia merck manuals professional edition. Rituximab therapy for pure red cell aplasia due to anti. In the pure red cell aplasia, there is only a reduction of the red blood cells however in aplastic anemia, there is pancytopenia or low red blood cell, white blood cell and even platelet counts.
Pure red cell aplasia prca is a rare disorder of erythropoiesis characterized. Pure red cell aplasia medhelps pure red cell aplasia center for information, symptoms, resources, treatments and tools for pure red cell aplasia. In people with prca, the bone marrow makes a reduced number of red blood cells called anemia. Pdf pure red cell aplasia following autoimmune hemolytic anemia. Pwca has been associated with autoimmune, druginduced, and viral exposures.
Pure red cell aplasia symptoms, treatments and resources. Pure red cell aplasia and lymphoma jama jama network. Pure red cell aplasia prca is defined as an acquired anemia secondary to absence or nearabsence of erythroid precursors in the bone marrow. Here, we report a case of a 74yearold female who presented with severe proximal weakness without pain and was found to have pwca with.
Standard exams like complete blood counts will also be taken along with chest xray, liver function tests, renal tests, vitamin deficiency tests. Feb 14, 2011 approach to normocytic anemia pure red cell aplasia check reticulocyte count normocytic anemia increased is there evidence of hemolysis. Pure red cell aplasia clinician information background antierythropoietin antibody associated pure red cell aplasia prca is a very rare cause of resistance characterised by transfusion dependency, low reticulocyte count, lack of proerythroid progenitor cells in the bone marrow and neutralising antierythropoietin antibodies 1. Although the incidence of pure red cell aplasia peaked in 2002, it remains important for nephrologists to know how to investigate a suspected case of pure red cell aplasia and how to identify other causes of hyporesponsiveness. Reyes syndrome rs, nephrogenic systemic fibrosis nsf, and pure red cell aplasia prca among chronic kidney disease ckd patients were. Pure red cell aplasia prca is a hematologic syndrome characterized by severe normochromic, normocytic anemia. Aug 18, 2009 acquired pure red cell aplasia is a rare disorder, usually appearing secondary to various pathologic conditions such as thymoma, systemic autoimmune diseases or in the course of lymphomas. Download figure open in new tab download powerpoint. Pure red cell aplasia prca is a syndrome defined by a normocytic normochromic anemia with severe reticulocytopenia and marked reduction or absence of erythroid precursors from the bone marrow. Additional and relevant useful information for pure red cell aplasia. Thus, uninterrupted use of tkis is of importance in such patients. Eprexassociated pure red cell aplasia and leachates. Jul 01, 2012 pure red cell aplasia prca, also known as erythroblastopenia, is characterized by a suppression of erythrocytes in the bone marrow.
Pure red cell aplasia pcra is a rare disorder of erythropoiesis characterized by a selective and severe decrease in erythrocyte precursors in an otherwise normal bone marrow. The result is a temporary or persistent severe anaemia. Pure red cell aplasia prca free download as powerpoint presentation. The treatment of pure red cell aplasia may be undertaken as. Pure red cell aplasia prca is a rare condition that affects the bone marrow. Limitations epoetin alfa comparator not included in the longterm safety. Pure red cell aplasia, acquired nord national organization. Pure red cell aplasia prca is syndrome of marrow failure characterized by the selective reduction or absence of erythroid precursors. Pure red cell aplasia associated with hepatitis c infection. Approach to normocytic anemia pure red cell aplasia check reticulocyte count normocytic anemia increased is there evidence of hemolysis. Pure redcell aplasia prca is a serious, life threatening rare condition of multifactorial causes manifested as severe anemia with absence of erythroid precursors in the bone marrow. Aids and pure red cell aplasia, american journal of. The amounts of white blood cells and platelet remain normal. In a retrospective analysis, the prevalence and outcome of pure red cell aplasia prca in 44 pts with major and bidirectional.
A bone marrow trephine biopsy revealed pure red cell aplasia prca showing severe erythroid hypoplasia. It is characterized by an absence of red cell precursors reticulocytes in. Learn vocabulary, terms, and more with flashcards, games, and other study tools. This is an extremely rare type of pure red cell aplasia prca and it commonly affects adults. Signs and symptoms may include fatigue, lethargy, andor abnormal paleness of the skin pallor due to the anemia the caused by the disorder. Lamivudineinduced pure red cell aplasia request pdf. Shortly after discontinuation of the procainamide preparation, a reticulocytosis and increasing hemoglobin level were observed. Furthermore, signs and symptoms of pure red cell aplasia may vary on an individual basis for each patient. Acquired pure red blood cell aplasia is a disorder of erythroid precursors that results in an isolated normocytic anemia. The main goals of treatment for pure red cell aplasia prca are to restore the production of red blood cells, maintain adequate hemoglobin levels, and treat underlying disorders that may be causing the condition.
The presentation and clinical course of pure red cell aplasia in 5 patients are described. Start studying aplastic anemia and pure red cell aplasia pp. It is defined by a normocytic, normochromic anemia with a marked reticulocytopenia and severe reduction or absence of erythroid precursors in the bone marrow. Chapter 32 pure red cell aplasia free medical textbook. Secondary prca can be associated with various haematological disorders, such as chronic lymphocytic leukaemia cll or nonhodgkin lymphoma nhl. Pure red cell aplasia and lymphoproliferative disorders. Pure red cell aplasia prca red blood cell bone marrow. Pure red cell aplasia hematology american society of. It is characterized by an absence of red cell precursors reticulocytes in the marrow and a low red blood cell count. To date, little has been published on the efficacy of rituximab on pure red cell aplasia due to antiepoetin antibodies. Pure red cell aplasia is morphologically characterized by severe lack of erythroid precursors in the bone marrow whereas myeloid precursors and megakaryocytic elements are unaffected and are present in normal numbers. Although it is rare, isolated cytogenetic abnormalities can be seen in prca, and.
Dec 26, 2011 pure red cell aplasia is caused by a selective destruction or inhibition of erythroid progenitor or precursor cells. The initial treatment plan typically includes blood transfusions for individuals who are severely anemic and have cardiorespiratory failure. Symptoms result from anemia and include fatigue, lethargy, decreased exercise tolerance and pallor. Dec 14, 2011 acquired pure red cell aplasia prca is a bone marrow disorder characterized by a reduction of red blood cells erythrocytes produced by the bone marrow. To examine clinical features, laboratory test results, treatment, and outcome of dogs with pure red cell aplasia prca. While treatment for pure red cell aplasia due to antiepoetin antibodies is usually with immunosuppressive therapy such as calcineurin inhibition, the safety of this treatment in chronic hepatitis c virus infection is unknown. Pure red cell aplasia genetic and rare diseases information.
Pure redcell aplasia in patients with chronic lymphocytic. No patient in any group developed neutralizing antibodies or pure red blood cell aplasia. Primary prca, or secondary prca which has not responded to treatment of the underlying disease, is treated as an immunologicallymediated disease. Pure red cell aplasia is caused by a selective destruction or inhibition of erythroid progenitor or precursor cells. Children with anemias often initially present to their pediatricians. Symptoms result from anemia and include fatigue, lethargy, decreased exercise tolerance, and pallor. Pure red cell aplasia prca was first described by kaznelson 1922 as an anemia due to an almost complete cessation of erythropoiesis, but without leukopenia or thrombocytopenia. Pure red cell aplasia due to persistent b19 parvovirus infection in patient infected with human immunodeficiency virus type 1. The acute pure red cell aplasia is a transient disorder and is seen primarily in childhood but can occur at all ages.
Pure red cell aplasia in patients with chronic lymphocytic leukemia. Pure red blood cell aplasia is an extremely unusual disorder, in which the patient presents with severe anemia, a marked reduction in circulating reticulocytes, and nonexistence of erythroid precursors in the bone marrow. Pure red cell aplasia blood american society of hematology. Pure red cell aplasia as first manifestation of splenic. Bone marrow contains stem cells which develop into the red blood cells that carry oxygen through the body, the white blood cells that fight infections, and the platelets that help with blood clotting. Blood group incompatibility between donor and recipient of allogeneic stem cell transplants may be associated with posttransplant erythroid aplasia. Pure red cell aplasia prca is a syndrome characterized by a severe normocytic anaemia, reticulocytopenia, and absence of erythroblasts from an otherwise normal bone marrow. Causes of pure red blood cell aplasia vary from immunological disorders and infectious agents to hematologic malignancies. Cook md, phd, in hematopathology third edition, 2018. Pure redcell aplasia and antierythropoietin antibodies in patients treated with recombinant erythropoietin. Conventional treatment consists of immunosuppression with corticosteroids, antithymocyte globulin or cyclosporina. It is a peculiar oddity that the bone marrows progenitor cells still differentiate into white blood cells and platelets. Pure red cell aplasia associated with administration of.
If the cause of pure red cell aplasia is an autoimmunerelated disorder, medications such as steroids can be provided to help reduce the symptoms. Pure red cell aplasia in patients who are treated for anemia of chronic kidney disease with erythropoiesisstimulating agents such as epoetin was first reported in 1998. Acquired pure red blood cell rbc aplasia prca is a rare hematologic disorder characterized by anemia, absence of reticulocytosis, erythroid hypoplasia in. Bone marrow showed a nearly complete lack of red cell precursors, thus favoring the diagnosis of acquired pure red cell aplasia prca. Multiple myeloma mm and pure red cell aplasia prca. In patients with congenital hypoplastic anemia the best results have been reported using corticosteroids. Identification of serious adverse drug reactions sadrs associated with commonly used drugs can elude detection for years. There is maturation arrest at the basophilic pronormoblastic phase in the bone marrow that is associated with reticulocytopenia and anemia. Prca may be a consequence of antibody production against applied recombinant human erythropoietin epo. Treatment of primary, idiopathic prca is immunosuppressive therapy. Anemia may result from blood loss, a destructive process ie, hemolysis, nutritional deficiency, or poor production eg, ineffective erythropoiesis or hypoplastic or aplastic marrow table. Pure red cell aplasia prca or erythroblastopenia refers to a type of anemia affecting the precursors to red blood cells but not to white blood cells. Pure red blood cell aplasia prca is characterized by purely normocytic, normochromic anemia, a very low level of reticulocytes, and a marked reduction or. Acquired pure red cell aplasia prca is a bone marrow disorder characterized by a reduction of red blood cells erythrocytes produced by the bone marrow.
We present, to the best of our knowledge, the first case. Histopathology images of pure red cell aplasia pra by. Pure red cell aplasia in dogs vetlexicon canis from. Pure redcell aplasia following major and bidirectional. In prca, the bone marrow ceases to produce red blood cells. Pure red cell aplasia prca is a hematologic syndrome characterized by severe normochromic, normocytic anemia associated with reticulocytopenia and absence of erythroblasts from an otherwise normal marrow. Primary and secondary forms of pure red cell aplasia have been described in dogs and cats. However, if it is properly managed from the early stages, it can be maintained and prevented from developing into its chronic form. Find pure red cell aplasia information, treatments for pure red cell aplasia and pure red cell aplasia symptoms. Daclizumab for pure redcell aplasia annals of internal. This is a case of a patient who presented with generalised weakness, dysphagia and ptosis. Affected individuals may experience fatigue, lethargy, andor abnormal paleness of the skin pallor. Pure redcell aplasia following major and bidirectional abo.
Pure red cell aplasia and antierythropoietin antibodies in patients treated with recombinant erythropoietin. Pure red cell aplasia clinician information rare renal. Pure red blood cell aplasia msd manual professional edition. Pure red cell aplasia prca is a rare syndrome that only affects the erythroid lineage. Differential diagnosis of pure red cell aplasia should include parvovirus b19 pvb19 infection, especially in immunologically incompetent hosts, like patients with nonsuppressed hiv. Pure red cell aplasia prca is a rare disorder, not previously known to be associated with tkis. The os and diseasefree probability at 510 years in our cohort were 0. Tyrosinekinase inhibitors tkis represent the only hopes for longterm survival for patients with chronic myeloid leukaemia cml and gastrointestinal stromal tumours.
We describe patients with unresponsive anemia in whom a. Acquired pure red cell aplasia prca is a rare cause of profound anemia characterized by a very low reticulocyte count and the virtual absence of erythroid precursors in the bone marrow. Pure white cell aplasia pwca is a rare hematologic disorder characterized by the absence of neutrophil lineages in the bone marrow with intact megakaryopoiesis and erythropoiesis. Pure red blood cell aplasia, acquired, usually presents as a severe condition. Acquired pure red cell aplasia genetic and rare diseases. Find details on pure red cell aplasia in dogs including diagnosis and symptoms, pathogenesis, prevention, treatment, prognosis and more. The authors suggest that prca may be related either to the underlying hiv infection or to antiretroviral medications, and they recommend corticosteroid treatment for these already immunocompromised patients. Signs and symptoms may include fatigue, lethargy, andor abnormal paleness of the skin pallor due to. The aim of this report is to describe five patients with lamivudineinduced pure red cell aplasia, an association not previously described. Pure red cell aplasia, british journal of haematology 10. Fulltext pdf subtype distribution, clinical features, and survival in bcell chronic lymphoproliferative disorders in china. Occasional cases have been reported with leucopenia or thrombocytopenia. Pdf pure red cell aplasia prca is an uncommon disorder in which maturation arrest occurs in the formation of erythrocytes. Pure red cell aplasia due to followon epoetin kidney.
Rational management approach to pure red cell aplasia. Jci retrovirusinduced feline pure red cell aplasia. Aplastic and hypoplastic anemias american academy of. The pathology of pure red cell aplasia rho chi post. In 1998, an increase in the incidence of pure red cell aplasia prca was observed that was associated with antierythropoietin antibodies and. Patients with acquired pure red cell aplasia will have absence of reticulocytes, which are red cell precursors, in the bone marrow. Acquired pure red cell aplasia in a patient with ankylosing. The management of pure red cell aplasia prca continues to challenge clinical investigators because the pathophysiology is heterogeneous and poorly understood. This is in contrast to shwachmanbodiandiamond syndrome, in which the bone marrow defect results primarily in. Pure red cell aplasia prca is a rare bone marrow failure syndrome defined by a progressive normocytic anaemia and reticulocytopenia without leukocytopenia and thrombocytopenia.
Pure red cell aplasia an overview sciencedirect topics. All other cell lineages are present in normal numbers and appear morphologically normal. This signs and symptoms information for pure red cell aplasia has been gathered from various sources, may not be fully accurate, and may not be the full list of pure red cell aplasia signs or pure red cell aplasia symptoms. Pure red cell aplasia definition of pure red cell aplasia. Free heme is toxic to cells, and it is hypothesized that the binding of felvc to. Detection of pvb19 in serum or bone marrow in the absence of. Pure red cell aplasia prca can be inherited diamond blackfan anemia, dba or acquired aprca.
Pure red blood cell aplasia and chronic lymphocytic leukemia. Secondary prca occurs in patients with conditions such as autoimmune disorders, thymomas, systemic lupus erythematosus, hematologic malignancies, and solid tumors. Pure red cell aplasia prca is an uncommon disorder in which maturation arrest occurs in the formation of erythrocytes. In 3 of them no concomitant diseases were present, in 1 the condition was associated with the presence of. It is characterized by an anemia and reticulocytopenia and occurs as an acute or chronic condition. Pure red cell aplasia prca is a rare bone marrow disorder characterized by absence of erythropoiesis and severe nonregenerative anemia. Between 1988 and 1998, antibodyassociated pure red cell aplasia was reported in three patients who had undergone treatment with recombinant human erythropoietin epoetin. Hematopoietic progenitors are infected with feline leukemia virus and erythroid burstforming cells are uniquely sensitive to heterologous complement. Four cases of pure red cell aplasia prca in association with chronic lymphocytic leukemia cll are summarized. Pdf pure red cell aplasia prca is an uncommon disorder in which maturation arrest occurs in the.
There are five treatment regimens that have established efficacy for patients with chronic prca. Pure red cell aplasia prca is an uncommon disorder in which maturation growth arrest occurs in the formation of erythrocytes red blood cells. A total of 548 patients pts received allogeneic transplant for malignant and nonmalignant hematologic disorders. Dba causes low red blood cell counts, without substantially affecting the other blood components the platelets and the white blood cells, which are usually normal. Antibodymediated pure red cell aplasia is a rare syndrome of anemia associated with a low reticulocyte count, an absence of erythroblasts in the bone marrow, resistance to recombinant human erythr. In a retrospective analysis, the prevalence and outcome of pure red cell aplasia prca in 44 pts with major and bi.
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