Summary
Inhibitory mechanisms of erythropoiesis in 20 patients with pure red cell aplasia (PRCA) were investigated using the technique of in vitro hematopoiesis and an assay for human parvovirus. Complement-dependent serum inhibitors against late erythroid progenitors (CFU-E) were demonstrated in seven of 19 patients examined, and complement-dependent inhibitors against early erythroid progenitors (BFU-E) were demonstrated in three of these seven patients. Nonspecific and complement-independent inhibitors against CFU-E were thought to be associated with the etiology of PRCA in one patient. Human parvovirus-mediated erythropoietic suppression was demonstrated in a patient with complete remission of acute lymphoblastic leukemia complicated with marrow erythroid aplasia, whose serum showed a perfect inhibition against erythroid progenitor cells. T-cell-mediated erythroid suppression was not demonstrated in the patients examined. These findings reveal that erythroid aplasia is associated with complement-dependent serum erythropoietic inhibitor in some patients (36.8% in the present study) with PRCA, but it is difficult to identify the mechanism of erythroid aplasia in more than half of the patients with PRCA. In addition, our present study discovered the presence of parvovirus-mediated marrow pure red cell aplasia in one adult patient with acute lymphoblastic leukemia.
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Abkowitz JL, Kadin JM, Powel JS, Adamson JW (1986) Pure red cell aplasia: lymphocyte inhibition of erythropoiesis. Br J Haematol 63: 59–67
Abkowitz JL, Powell JS, Nakamura JM, Kadin ME, Adamson JW (1986) Pure red cell aplasia: response to therapy with antithymocyte globulin. Am J Hematol 23: 363–371
Coulombel L, Morinet F, Mielot F, Tchernia G (1989) Parvovirus infection, leukemia, and immunodeficiency. Lancet 1: 101–102
Krantz SB, Moore WH, Zaents SD (1973) Studies on red cell aplasia. V. Presence of erythroblast cytotoxicity in gammaG-globulin fraction of plasma. J Clin Invest 52: 324–336
Kurtzman GJ, Ozawa K, Cohen B, Hanson G, Oseas R, Young NS (1987) Chronic bone marrow failure due to persistent B 19 parvovirus infection. N Engl J Med 317: 287–294
Kurtzman GJ, Cohen B, Meyers P, Amunullah A, Young NS (1988) Persistent B 19 parvovirus infection as a cause of severe chronic anemia in children with acute lymphocytic leukemia. Lancet 2: 1159–1162
Kurtzman G, Frickhofen N, Kimball J, Jenkins DW, Nienhuis AW, Young NS (1989) Pure red-cell aplasia of 10 years' duration due to persistent parvovirus B19 infection and its cure with immunoglobulin therapy. N Engl J Med 321: 519–523
Mangan KF, D'Alessandro L (1985) Hypoplastic anemia in B-cell chronic lymphocytic leukemia: evolution of T-cell-mediated suppression of erythropoiesis in early stage and late stage disease. Blood 65: 533–541
Messner HA, Fauser AA, Curtis JE, Dotten D (1981) Control of antibody-mediated pure red cell aplasia by plasmapheresis. N Engl J Med 304: 1334–1338
Nagasawa T, Abe T, Nakagawa T (1981) Pure red cell aplasia and hypogammaglobulinemia associated with T gamma-cell chronic lymphocytic leukemia. Blood 57: 1025–1031
Peschle C, Marmont AM, Marone G, Genovese A, Sasso G, Condorelli M (1975) Pure red cell aplasia: studies on an IgG serum inhibitor neutralizing erythropoietin. Br J Haematol 30: 411–417
Takahashi M, Keating A, Singer J (1985) A functional defect on irradiated adherent layers from chronic myelogenous leukemia long-term marrow cultures. Exp Hematol 13: 926–931
Takahashi M, Koike T, Moriyama Y, Shibata A, Koike R, Sanada M, Tsukada T (1986) Inhibition of erythropoiesis by human parvovirus-containing serum from a patient with hereditary spherocytosis in aplastic crisis. Scand J Haematol 37: 118–124
Takahashi M, Shibata A, Takai K, Sanada M (1991) Anemia caused by parvovirus in an adult patient with acute lymphoblastic leukemia in complete remission. Eur J Haematol 46: 47
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Takahashi, M., Nikkuni, K., Tanaka, I. et al. Serum erythropoietic inhibitors in patients with pure red cell aplasia. Ann Hematol 63, 9–14 (1991). https://doi.org/10.1007/BF01714954
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DOI: https://doi.org/10.1007/BF01714954