ESA-induced pure red cell aplasia presenting as a precipitous hemoglobin drop in end-stage renal disease.

Case reportArchive of clinical cases· 2026

ESA-induced pure red cell aplasia presenting as a precipitous hemoglobin drop in end-stage renal disease.

James Seng Koon Mui

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NephrologyCase reportDiagnosis

Erythropoiesis-stimulating agent therapy linked to pure red cell aplasia, hemoglobin fell to 6.8 g/dL

ESA-induced pure red cell aplasia presenting as a precipitous hemoglobin drop in end-stage renal disease.

James Seng Koon Mui

Archive of clinical cases · 2026

Background

Anemia is a nearly universal complication of chronic kidney disease (chronic kidney disease).

6.8

Results

6.8

g/dL

his hemoglobin plunged to a dangerously low level

More results

Diagnosis is often delayed as clinical focus frequently shifts toward more common causes of acute anemia, such as hemorrhage.

Investigation revealed replete hematinics but profound reticulocytopenia.

Anti-EPO antibody testing was not performed, which limits definitive etiological confirmation.

More results

Due to the high risk of immunosuppression in an elderly patient and the limited accessibility of hypoxia-inducible factor-prolyl hydroxylase inhibitors (hypoxia-inducible factor-prolyl hydroxylase inhibitors), management was restricted to erythropoiesis-stimulating agents cessation and supportive transfusions.

“

Conclusion

In chronic hemodialysis patients, early recognition of iatrogenic pure red cell aplasia is essential to prevent the continued administration of potentially harmful erythropoiesis-stimulating agents and to facilitate a transition toward alternative therapies, such as hypoxia-inducible factor-prolyl hydroxylase inhibitors.

ESA-induced pure red cell aplasia presenting as a precipitous hemoglobin drop in end-stage renal disease.

ESA-induced pure red cell aplasia presenting as a precipitous hemoglobin drop in end-stage renal disease.

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