Pure Red Cell Aplasia Induced by Fk506

Suzuki, Shigetoshi; Osaka, Yoshio; Nakai, I; Yasumura, Tadaki; Omori, Yoshihiro; Yamagata, Noboru; Shimazaki, Chihiro; Oka, Takahiro

doi:10.1097/00007890-199603150-00026

Cited by 25 publications

(18 citation statements)

References 3 publications

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“…A decrease in the dose of tacrolimus improved nephrotoxicity, indicating it was a reversible adverse effect. Although a few cases of tacrolimus‐associated PRCA due to drug toxicity have been documented (Suzuki et al. , 1996; Misra et al.…”

Section: Discussionmentioning

confidence: 99%

Effect of tacrolimus in a patient with pure red-cell aplasia

et al. 2005

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A 78-year-old woman has suffered from pure red-cell aplasia (PRCA) associated with generalized myasthenia gravis and thymoma. Cyclosporin A (CyA) with corticosteroid increased numbers of erythroid cells in her bone marrow cells but she required monthly blood transfusions. Administration of tacrolimus as a substitution for CyA inhibited progression of anemia without the need for further blood transfusion. No serious side effects were observed. This case demonstrates that tacrolimus is another option of treatment for PRCA in patients who fail to respond to CyA.

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Section: Discussionmentioning

confidence: 99%

Effect of tacrolimus in a patient with pure red-cell aplasia

et al. 2005

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“…Hematologic toxicity has been rarely attributed to tacrolimus, a macrolide immunosuppressant. PRCA had been reported in one adult patient post‐renal transplantation (51), and two children post‐liver transplantation (26) on tacrolimus therapy. PRCA was reversible in all cases with a rapid resolution of anemia within 2 wk after discontinuation of tacrolimus in favor of CsA maintenance therapy.…”

Section: Tacrolimus (Fk506)mentioning

confidence: 99%

Anemia in children after transplantation: etiology and the effect of immunosuppressive therapy on erythropoiesis

Al‐Uzri

Yorgin

Kling

2003

Pediatric Transplantation

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Anemia in children after renal transplantation is more common than previously appreciated. Multiple factors appear to play roles in the development of post-transplant anemia, the most common of which is absolute and/or functional iron deficiency anemia. Most experts recommend that iron limited anemias in transplant patients should be diagnosed using the same criteria as for chronic renal failure patients. Serum erythropoietin (EPO) levels are expected to normalize after a successful renal transplantation with a normal kidney function, yet both EPO deficiency and resistance have been reported. While no large controlled trials comparing the effect of different immunosuppressive agents on erythropoiesis after transplantation have been performed, generalized bone marrow suppression attributable to azathioprine (AZA), mycophenolate mofetil (MMF), tacrolimus, antithymocyte preparations has been reported. Pure red cell aplasia (PRCA) occurs rarely after transplantation and is characterized by the selective suppression of erythroid cells in the bone marrow. PRCA has been reported with the use of AZA, MMF, tacrolimus, angiotensin converting enzyme inhibitors (ACEI), but not with cyclosporine (CSA) use. Post-transplant hemolytic uremic syndrome has been reported with orthoclone anti T-cell antibody (OKT3), CSA and tacrolimus therapy. Viral infections including cytomegalovirus, Epstein-Barr virus and human parvovirus B19 have been reported to cause generalized marrow suppression. Management of severe anemia associated with immunosuppressive drugs generally requires lowering the dose, drug substitution or, when possible, discontinuation of the drug. Because this topic has been incompletely studied, our recommendation as to the best immunosuppressive protocol after renal transplantation remains largely dependent on the clinical response of the individual patient.

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“…Tacrolimus can bind to FKBP in T lymphocytes and the final outcome is inhibition of the gene transcription for IL-2 and other transcription factors essential to early T cell activation [4]. Hematopoietic abnormalities associated with tacrolimus are rare with reversible pure red cell aplasia the most common [5][6][7][8]. The mechanism by which tacrolimus causes bone marrow hypoplasia is unclear.…”

Section: Discussionmentioning

confidence: 99%

“…The hematopoietic abnormalities associated with tacrolimus are relatively rare. There are very few case reports of reversible pure red cell aplasia (PRCA) [5,6] and generalized bone marrow suppression [7,8] in transplantation recipients following the use of tacrolimus. The bone marrow suppression associated with tacrolimus appears to be reversible as all the patients in the case reports recovered after tacrolimus was discontinued.…”

Section: Introductionmentioning

confidence: 99%