Pure Red Cell Aplasia Secondary to Rheumatoid Arthritis

Abstract BackgroundRheumatoid arthritis (RA) is a common autoimmune disease with many extra-articular manifestations. Pure red cell aplasia (PRCA) is a rare manifestation of RA and is sparsely documented in the literature with a variable clinical outcome following immunosuppressive therapy. Case presentationA 63-year-old female presented with transfusion-dependent anaemia associated with deforming inflammatory arthritis, who also had leukopenia, right subclavian venous thrombosis, and generalized lymphadenopathy. The diagnosis of RA following initial clinical workup and additional blood and bone marrow investigations revealed PRCA as a secondary manifestation of RA after excluding other secondary causes, such as infections, thymoma, thrombophilic conditions and haematological malignancy. She responded well to oral prednisolone, cyclosporine A and hydroxychloroquine, where she attained complete recovery in two months. ConclusionPRCA is a disabling illness that may lead to transfusion-dependent anaemia, which may occur due to rare extrapulmonary manifestation of RA. The diagnosis of PRCA secondary to RA may be challenging where haematological investigations, including bone marrow biopsy, will aid in the diagnosis, and early diagnosis and treatment will bring about a better outcome.

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Pure red cell aplasia secondary to rheumatoid arthritis: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03141-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Suneth Weerasinghe ◽

Parackrama Karunathilake ◽

Udaya Ralapanawa ◽

Thilak Jayalath ◽

Shamali Abeygunawardena ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Bone Marrow ◽

Oral Prednisolone ◽

Complete Recovery ◽

Pure Red Cell Aplasia ◽

Red Cell ◽

Case Presentation ◽

Red Cell Aplasia ◽

Rare Manifestation ◽

Generalized Lymphadenopathy

Abstract Background Rheumatoid arthritis is a common autoimmune disease with many extra-articular manifestations. Pure red cell aplasia is a rare manifestation of rheumatoid arthritis and is sparsely documented in the literature, with a variable clinical outcome following immunosuppressive therapy. Case presentation A 63-year-old Sinhalese female presented with transfusion-dependent anemia associated with deforming inflammatory arthritis. She also had leukopenia, right subclavian venous thrombosis, and generalized lymphadenopathy. The diagnosis of rheumatoid arthritis following initial clinical workup and additional blood and bone marrow investigations revealed pure red cell aplasia as a secondary manifestation of rheumatoid arthritis after excluding other secondary causes, such as infections, thymoma, thrombophilic conditions, and hematological malignancy. She responded well to oral prednisolone, cyclosporine A, and hydroxychloroquine, and she attained complete recovery in 2 months. Conclusion Pure red cell aplasia is a disabling illness that may lead to transfusion-dependent anemia, which may occur due to rare extrapulmonary manifestation of rheumatoid arthritis. The diagnosis of pure red cell aplasia secondary to rheumatoid arthritis may be challenging where hematological investigations, including bone marrow biopsy, will aid in the diagnosis, and early diagnosis and treatment will bring about a better outcome.

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PURE RED CELL APLASIA : A CASE REPORT

10.36106/ijar/9702236 ◽

2021 ◽

pp. 55-56

Author(s):

G Srivani ◽

D Roja Aishwarya ◽

P. V. S. Kiran

Keyword(s):

Bone Marrow ◽

Bone Marrow Failure ◽

Bone Marrow Aspiration ◽

Oral Prednisolone ◽

Pure Red Cell Aplasia ◽

Red Cell ◽

Red Cell Aplasia ◽

Normocytic Normochromic Anemia ◽

Pure Cell ◽

Normochromic Anemia

Pure cell aplasia is a rare bone marrow failure that affects erythroid lineage characterized by normocytic normochromic anemia with reticulocytopenia in the peripheral blood and absent or infrequent erythroblasts in the bone marrow. It can be congenital or acquired. Acquired can be primary when no cause is identied or secondary-due to underlying or associated pathology. Herein we report a case of a 28 year old female with Primary Acquired Pure Red cell aplasia. The patient presented with severe anemia (Hb-1.9gm%) and low reticulocyte count 0.1%. Bone marrow aspiration shows normocellular marrow with Decreased erythropoiesis with M:E ratio of 20:1..Patient was started on oral prednisolone and improvement was seen and the patient became transfusion independent.

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Anemia: Production Defects Generally Associated with Marrow Aplasia or Replacement

10.2310/fm.1339 ◽

2017 ◽

Author(s):

Nancy Berliner ◽

John M Gansner

Keyword(s):

Bone Marrow ◽

Differential Diagnosis ◽

Aplastic Anemia ◽

Blood Smear ◽

Pure Red Cell Aplasia ◽

Red Cell ◽

Normal Bone Marrow ◽

Normal Bone ◽

Red Cell Aplasia

This review focuses on anemia resulting from production defects generally associated with marrow aplasia or replacement. The definition, epidemiology, etiology, pathogenesis, diagnosis, differential diagnosis, management, complications, and prognosis of the following production defects are discussed: Acquired aplastic anemia and acquired pure red cell aplasia. Figures depict a leukoerythroblastic blood smear, a biopsy comparing normal bone marrow and bone marrow showing almost complete aplasia, and a marrow smear. A table lists the causes of aplastic anemia. This review contains 3 figures; 1 table; 108 references.

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Recovery of erythropoiesis following allogeneic bone marrow transplantation for chronic lymphocytic leukaemia-associated pure red cell aplasia

Bone Marrow Transplantation ◽

10.1038/sj.bmt.1702992 ◽

2001 ◽

Vol 27 (7) ◽

pp. 771-773 ◽

Cited By ~ 3

Author(s):

MP de Vetten ◽

M van Gelder ◽

GE de Greef

Keyword(s):

Bone Marrow ◽

Bone Marrow Transplantation ◽

Chronic Lymphocytic Leukaemia ◽

Marrow Transplantation ◽

Lymphocytic Leukaemia ◽

Allogeneic Bone Marrow Transplantation ◽

Pure Red Cell Aplasia ◽

Allogeneic Bone ◽

Red Cell ◽

Red Cell Aplasia

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Pure red cell aplasia caused by Parvo B19 virus in a kidney transplant recipient

Journal of Nepal Medical Association ◽

10.31729/jnma.73 ◽

2012 ◽

Vol 52 (186) ◽

Cited By ~ 2

Author(s):

A Baral ◽

B Poudel ◽

R K Agrawal ◽

R Hada ◽

S Gurung

Keyword(s):

Bone Marrow ◽

Transplant Recipient ◽

Intravenous Immunoglobulin ◽

Kidney Transplant ◽

Parvovirus B19 ◽

Kidney Transplant Recipient ◽

Pure Red Cell Aplasia ◽

Red Cell ◽

Erythroid Progenitor ◽

Red Cell Aplasia

Parvo B19 is a single stranded DNA virus, which typically has affi nity for erythroid progenitor cells in the bone marrow and produces a severe form of anemia known as pure red cell aplasia. This condition is particularly worse in immunocompromised individuals. We herein report a young Nepali male who developed severe and persistent anaemia after kidney transplantation while being on immunosuppressive therapy. His bone marrow examination revealed morphological changes of pure red cell aplasia, caused by parvovirus B19. The IgM antibody against the virus was positive and the virus was detected by polymerase chain reaction in the blood. He was managed with intravenous immunoglobulin. He responded well to the treatment and has normal hemoglobin levels three months post treatment. To the best of our knowledge, this is the fi rst such case report from Nepal. Keywords: Intravenous immunoglobulin, kidney transplant recipient, Parvovirus B19, pure red cell aplasia.

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Reduced intensity conditioning bone marrow transplantation for pure red cell aplasia: successful outcome but difficult post transplant course

Bone Marrow Transplantation ◽

10.1038/sj.bmt.1704993 ◽

2005 ◽

Vol 36 (1) ◽

pp. 81-82 ◽

Cited By ~ 6

Author(s):

G Kochethu ◽

H S Baden ◽

E Jaworska ◽

J Chang ◽

R Chopra

Keyword(s):

Bone Marrow ◽

Bone Marrow Transplantation ◽

Marrow Transplantation ◽

Pure Red Cell Aplasia ◽

Successful Outcome ◽

Red Cell ◽

Reduced Intensity Conditioning ◽

Post Transplant ◽

Red Cell Aplasia ◽

Reduced Intensity

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Carbamazepine-Induced Pure Red Cell Aplasia

International Journal of Epilepsy ◽

10.1055/s-0038-1657851 ◽

2018 ◽

Vol 05 (01) ◽

pp. 050-052 ◽

Cited By ~ 1

Author(s):

C. Mansoor ◽

Laksmi Priya

Keyword(s):

Bone Marrow ◽

Rare Disease ◽

Pure Red Cell Aplasia ◽

Normocytic Anemia ◽

Red Cell ◽

Normal Bone Marrow ◽

Hematologic Disorders ◽

Normal Bone ◽

Red Cell Aplasia ◽

Carbamazepine Therapy

AbstractAntiepileptic therapy is associated with various hematologic disorders. Pure red cell aplasia (PRCA) is a rare disease that may be congenital or acquired. Severe normocytic anemia, reticulocytopenia, and absence of erythroblasts from an otherwise normal bone marrow should raise the suspicion of PRCA. A 32-year-old unmarried woman was admitted with fatigue for 4 months. She had been on carbamazepine therapy for 4 years (200 mg twice daily) for seizure disorder. On evaluation, she was diagnosed to have PRCA secondary to carbamazepine. We describe a patient with carbamazepine-induced PRCA that improved after discontinuation of the drug.

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