A CASE OF PURE RED-CELL APLASIA - FOLLOW-UP ON DIFFERENT IMMUNOSUPPRESSIVE REGIMENS

A 66-year-old patient was admitted to our hospital in January 1992 for further evaluation of severe normocytic anemia. Hemoglobin (Hb) was 3 .5 g/dl, reticulocyte count 1 parts per thousand. Bone marrow showed a nearly complete lack of red cell precursors, thus favoring the diagno sis of acquired pure red cell aplasia (PRCA). Immunosuppressive therap y with prednisolone was started but had to be supplemented with azathi oprine because of a further rapid decrease in Hb to 3.7 g/dl after an initial transfusion of 6 U red blood cells. However, with this regimen a renewed decrease in Hb to 6.6 g/dl was noted, and further transfusi ons were required. Therefore therapy was switched to cyclosporine A (C yA) while tapering off prednisolone. Four months after the initial dia gnosis a positive parvovirus B19 IgM antibody was found. After the fai lure of hematological remission with three immunosuppressive regimens a course of high-dose intravenous immunoglobulins (IVIG) was administe red in July 1992. Six weeks after IVIG therapy a peak hemoglobin conce ntration of 12.3 g/dl was noted, and further transfusion was not requi red. CyA was tapered off in October 1992. One month later CyA was rein stituted because of a relapse of PRCA but was unsuccessful until Janua ry 1993. At this time immunosuppressive CyA therapy was discontinued b ecause of a periodontal abscess. In February 1993 a second IVIC infusi on was given, and a second remission of PRCA was noted, showing an inc rease in hemoglobin up to 14.5 g/dl by November 1993. At the last foll ow-up visit in February 1994 our patient was still in complete hematol ogical remission.