Pure red cell aplasia due to parvovirus b19 infection in solid organ transplantation. Approach to normocytic anemia pure red cell aplasia check reticulocyte count normocytic anemia increased is there evidence of hemolysis. 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. Here, we report a case of a 74yearold female who presented with severe proximal weakness without pain and was found to have pwca with. He was started on subcutaneous followon epoetinalfa, wepox wockhardt limited india, mumbai, india and 10 weekly doses of.
Although it is rare, isolated cytogenetic abnormalities can be seen in prca, and. Pure red cell aplasia prca is a rare syndrome that only affects the erythroid lineage. Find details on pure red cell aplasia in dogs including diagnosis and symptoms, pathogenesis, prevention, treatment, prognosis and more. May 03, 2017 pure red cell aplasia prca is an uncommon disorder in which maturation arrest occurs in the formation of erythrocytes. Pure red cell aplasia genetic and rare diseases information. In another case a patient with lamivudineassociated pure red cell aplasia required 15 units of blood over 3 weeks but recovered swiftly after withdrawal of lamivudine 109 a.
The management of pure red cell aplasia prca continues to challenge clinical investigators because the pathophysiology is heterogeneous and poorly understood. A study of patients with pure red cell aplasia associated. Acquired prca may be either a primary disorder or secondary to some other disorder or agent. It is defined by a normocytic, normochromic anemia with a marked reticulocytopenia and severe reduction or absence of erythroid precursors in the bone marrow. Jan 06, 2019 additional and relevant useful information for pure red cell aplasia. Pure red cell aplasia prca is an uncommon disorder in which maturation growth arrest occurs in the formation of erythrocytes red blood cells. Pure red cell aplasia was first separated from aplastic anemia by kaznelson in 1922. Approximately 50% of adults with prca have thymomas. Prca may present at any age, but most cases are reported in adults and adolescents.
Pure red cell aplasia an overview sciencedirect topics. A case of pure red cell aplasia linkedin slideshare. It is a peculiar oddity that the bone marrows progenitor cells still differentiate into white blood cells and platelets. All other cell lines are present and seem quantitatively and morphologically normal. Antibodymediated pure red cell aplasia prca treatment and retreatment. Public consultation 2017 pure red cell aplasia 1 2017 v3. Pure red cell aplasia prca associated with recombinant human erythropoietin rhuepo treatment anemia unresponsive to rhuepo treatment prca associated with erythropoietin treatment followed by a sudden decrease more than or equal to 2 gram per deciliter within 30 days in a previously stable hemoglobin level.
We recently experienced a case of acute viral hepatitis a complicated by pure red cell aplasia. The lack of red blood cells causes anemia which is classed as nonregenerative. Acquired pure red cell aplasia prca in adults is often persistent and may respond to immunosuppression. Apr 21, 2016 pure red cell aplasia prca is a rare condition that affects the bone marrow. Myelodysplastic syndrome with pure red cell aplasia shows. Pure red blood cell aplasia prca is characterized by purely normocytic, normochromic anemia, a very low level of reticulocytes, and a marked reduction or. Pure red cell aplasia secondary to pregnancy, characterization of a syndrome. In patients with congenital hypoplastic anemia the best results have been reported using corticosteroids. Symptoms result from anemia and include fatigue, lethargy, decreased exercise tolerance and pallor.
A 57yearold man with endstage renal disease secondary to chronic interstitial nephritis was initiated on hemodialysis in february 2006 for uremic symptoms. Isoniazid induced pure red blood cell aplasia cureus. Pure red cell aplasia prca is a rare bone marrow failure syndrome defined by a progressive normocytic anaemia and reticulocytopenia without. It is one of a group of bone marrow failure syndromes. Acquired prca in children is often transient and may be secondary to viral infections including. Pure redcell aplasia due to parvovirus b19 infection in a patient treated with alemtuzumab. Longterm outcome of patients with acquired chronic pure red cell aplasia prca following immunosuppressive therapy. In kore a, no case of pure red cell aplasia caused by acute hepatitis a ha s yet been reported. Diagnosis requires demonstration of peripheral normocytic anemia and a.
Symptoms of pure rbc aplasia are generally mild and relate to the degree of the anemia or to the underlying disorder. In people with prca, the bone marrow makes a reduced number of red blood cells called anemia. Pure red cell aplasia definition of pure red cell aplasia. Additional and relevant useful information for pure red cell aplasia. Most cases were observed in patients treated with epoetin alfa produced outside the united states. Sustained isolated rca is called pure red cell aplasia prca epidemiology.
Pure red blood cell aplasia prca is one of the uncommon causes of anemia. In prca, the bone marrow ceases to produce red blood cells. Acquired pure red cell aplasia is a rare disorder affecting males and females in equal numbers. To examine clinical features, laboratory test results, treatment, and outcome of. To examine clinical features, laboratory test results, treatment, and outcome of dogs with pure red cell aplasia prca. The patient was successfully treated with corticosteroids. The result is a temporary or persistent severe anaemia.
The amounts of white blood cells and platelet remain normal. The onset of pure red blood cell anemia usually is insidious, often occurring over weeks or months. Feb 14, 2011 approach to normocytic anemia pure red cell aplasia check reticulocyte count normocytic anemia increased is there evidence of hemolysis. There are five treatment regimens that have established efficacy for patients with chronic prca. Acquired pure red blood cell rbc aplasia prca is a rare hematologic disorder characterized by anemia, absence of reticulocytosis, erythroid hypoplasia in the bone marrow, and no abnormalities of the myeloid and megakaryocytic lines. Mds with pure red cell aplasia prca is a rare form of mds that has been proposed. Pdf pure red cell aplasia and cyclosporine fernando. We present, to the best of our knowledge, the first case of a. This is a rare syndrome 129 thought to be caused by. 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.
It is defined by a normocytic, normochromic anemia with a marked reticulocytopenia and severe reduction or. Signs and symptoms may include fatigue, lethargy, andor abnormal paleness of the skin pallor due to the anemia the caused by the disorder. Any defect resulting in failure of bone marrow to produce adequate erythroid cells emedicine. Dec 11, 2014 up to april 2009, 41 cases of pure red cell aplasia had been reported worldwide in association with mycophenolate mofetil. This is a form of anemia in which the bone marrow stops making red blood cells and this condition is known as pure red cell aplasia prca. The association of red cell aplasia and thymoma interested physicians in the 1930s and ultimately led to laboratory studies linking pure red cell aplasia to immune mechanisms, including the early identification of antierythroid precursor cell antibodies by. Here, we report a case of a 74yearold female who presented with severe proximal weakness without pain and was.
Pure red blood cell aplasia hematology and oncology. Pure red cell aplasia prca, also known as erythroblastopenia, is characterized by a suppression of erythrocytes in the bone marrow. Pure rca predominates in adolescents and adults but can affect any age pathogenesis of secondary pure red cell aplasia. 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. 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. The condition has been first described by paul kaznelson in 1922. Pure red cell aplasia blood american society of hematology. Pure red blood cell aplasia merck manuals professional edition. Aplasia comes from a greek word a which means not and plasis meaning molding. Jul 01, 2002 primary pure red cell aplasia in dogs. Pure red cell aplasia prca is a rare hematological disease characterized by.
Pure red cell aplasia hematology american society of. With picmonic, get your life back by studying less and remembering more. The amounts of white blood cells and platelet remain normal transient or acute selflimited prca. The association of red cell aplasia and thymoma interested physicians in the 1930s and ultimately led to laboratory studies linking pure red cell aplasia to immune mechanisms, including the early identification of antierythroid precursor cell antibodies by krantz and later characterization of t cells that inhibited erythropoiesis. Public consultation 2017 pure red cell aplasia 2 role of ig therapy. Pure red cell aplasia has been attributed to lamivudine in a 29yearold woman. Acquired pure red cell aplasia is thought to be an autoimmune disorder possibly caused either by a tumor of the thymus gland, certain drugs or a viral infection. 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 redcell aplasia secondary to pregnancy, characterization of a syndrome.
Jul 01, 2012 pure red cell aplasia prca, also known as erythroblastopenia, is characterized by a suppression of erythrocytes in the bone marrow. Symptoms related to anemia include fatigue, lethargy, decreased exercise tolerance, and pallor. Prca pure red cell aplasia is a bone marrow disorder failure to produce red blood cells. The condition may be caused by some virus infections, some drugs, cancers, rheumatoid arthritis and systemic lupus erythematosus. Pure red blood cell aplasia and chronic lymphocytic.
However, if it is properly managed from the early stages, it can be maintained and prevented from developing into its chronic form. Diamondblackfan anemia is a congenital form of prca. Pure red cell aplasia prca is characterized by a severe normocytic, normochromic, nonregenerative anemia along with erythroid hypoplasia and increased lymphocyte numbers in the bone marrow. Incidence of rca varies by specific subtype, the rarest is diamondblackfan anemia. Although it is rare, isolated cytogenetic abnormalities can be. Pure red cell aplasia and lymphoproliferative disorders. Nov 24, 2016 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.
Treatment of primary, idiopathic prca is immunosuppressive therapy. Our results indicated that it might be important to combine immunosuppressive drugs with an antiviral drug in the management of prca associated with cmv and. Prca pure red cell aplasia second chance aiha dogs. Pwca has been associated with autoimmune, druginduced, and viral exposures. Pure red cell aplasia prca is a syndrome defined by a normocytic normochromic anemia with severe reticulocytopenia and marked reduction or absence of. Pure red cell aplasia in dogs vetlexicon canis from. Pure red cell aplasia prca is defined as an acquired anemia secondary to absence or nearabsence of erythroid precursors in the bone marrow. The pathology of pure red cell aplasia rho chi post. Pure red cell aplasia due to followon epoetin kidney.
It is characterized by an absence of red cell precursors reticulocytes in the marrow and a low red blood cell count. This is an uncommon life threatening clinical condition with severe anaemia, very low reticulocyte numbers and a selective deficiency of erythroid progenitors demonstrated on bone marrow biopsy. Cook md, phd, in hematopathology third edition, 2018. Acquired pure red cell aplasia prca is a rare condition of profound anemia characterized by a very low reticulocyte count and the virtual absence of erythroid precursors in the bone marrow. Know the types, causes, symptoms, treatment, risk factors and diagnosis of pure red cell aplasia prca. Pure red blood cell aplasia hematology and oncology msd. Secondary prca occurs in patients with conditions such as autoimmune disorders, thymomas, systemic lupus erythematosus, hematologic malignancies, and solid tumors. Pure red cell aplasia is a type of anaemia in which there is a selective. 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. Acquired pure red cell aplasia in a patient with ankylosing. It would include the aplasia cutis congenital wherein there is a congenital absence of skin. Pure red cell aplasia associated with cytomegalovirus and epstein. Up to april 2009, 41 cases of pure red cell aplasia had been reported worldwide in association with mycophenolate mofetil. Pure redcell aplasia and epoetin therapy article pdf available in new england journal of medicine 35114.
Baby red cells called erythroblasts are almost absent in bone marrow. Acquired pure red blood cell aplasia is a disorder of erythroid precursors that results in an isolated normocytic anemia. This is a very rare condition and usually affects adults. Starting in 1998, the number of pure redcell aplasia prca cases in patients treated with recombinant human erythropoietin rhuepo increased dramatically. Pure red cell aplasia prca is a rare disorder, not previously known to be associated with tkis. Pure red blood cell aplasia, acquired, usually presents as a severe condition. Patients with acquired pure red cell aplasia will have absence of reticulocytes, which are red cell precursors, in the bone marrow. Tyrosinekinase inhibitors tkis represent the only hopes for longterm survival for patients with chronic myeloid leukaemia cml and gastrointestinal stromal tumours. Acquired pure red cell aplasia genetic and rare diseases. Pure red cell aplasia is a rare condition that occurs in congenital and acquired forms. However, if it is properly managed from the early stages, it can be maintained and. 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. Thus, uninterrupted use of tkis is of importance in such patients. Rituximab to treat moderate aplastic anemia, pure red cell.
Pure red cell aplasia prca is a rare condition that affects the bone marrow. Some forms of pure red cell aplasia are congenital present at birth, whereas are others are acquired as a result of an underlying autoimmune disease, immunosuppression, medications, and viruses. Sep 29, 2005 this is a nonrandomized, off label, pilot study of humanized anti cd20 rituximab rituxan in patients with moderate aplastic anemia, pure red cell aplasia or diamondblackfan anemia who have either failed to respond to at least one prior course of immunosuppressive therapy prcadba patients onlyor who have relapsed disease after prior immunosuppressive therapy prcadba patients only. It is defined by a normocytic, normochromic anemia with a marked. Pure red cell aplasia near absence of red blood cell precursors in bone marrow with associated anemia and reticulocytopenia normal numbers of megakaryocytes and white blood cell precursors. Red blood cell precursors unable to reach maturity. Jun 14, 2019 acquired pure red cell aplasia prca is a rare condition of profound anemia characterized by a very low reticulocyte count and the virtual absence of erythroid precursors in the bone marrow. This results in anemia and reticulocytopenia, which is a condition where there is absence of young red cells. Efficacy and longterm outcome of treatment for pure red cell aplasia after allogeneic stem cell transplantation from major aboincompatible donors. This is an extremely rare type of pure red cell aplasia prca and it commonly affects adults. Pure red cell aplasia, acquired nord national organization.