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Published on: September 6, 2017
Azathioprine-induced pure red cell aplasia: case report and review
A Agrawal1, N R Parrott, H N Riad
1Transplant Unit, Manchester Royal Infirmary, Manchester M13 9WL, UK.
Abstract:
The major adverse effect of azathioprine is its myelotoxicity, with leukocytes being affected more commonly than the other bone marrow elements. Although megaloblastic change is frequent, reportedly seen in 16% to 82% of bone marrow aspirates, long-term use of azathioprine rarely causes severe anemia. We report a case of refractory pure red cell aplasia resulting from long-term use of azathioprine in a renal transplant recipient and examine the possible underlying mechanisms. There was no response to dose reduction or to erythropoietin administration. However, there was immediate recovery after complete drug withdrawal. A review of the literature revealed that only ten cases of azathioprine-induced red cell aplasia have so far been described, all in transplant recipients.
Insights
Long-term azathioprine use can cause rare, severe anemia called pure red cell aplasia in transplant patients. Complete drug withdrawal led to immediate recovery, highlighting its importance in managing this adverse effect.
Area of Science:
- Immunosuppressive therapy
- Hematology
- Transplantation medicine
Background:
- Azathioprine is a common immunosuppressant, with myelotoxicity being a known side effect.
- While megaloblastic changes are frequent, severe anemia is an uncommon complication of azathioprine therapy.
Observation:
- A renal transplant recipient on long-term azathioprine developed refractory pure red cell aplasia.
- The condition did not improve with azathioprine dose reduction or erythropoietin treatment.
Findings:
- Complete withdrawal of azathioprine resulted in immediate recovery of red blood cell production.
- Literature review identified only ten previous cases of azathioprine-induced red cell aplasia, all in transplant recipients.
Implications:
- Azathioprine should be considered as a potential cause of pure red cell aplasia in transplant patients.
- Discontinuation of azathioprine is an effective treatment for this rare adverse effect.
- Further research into the mechanisms of azathioprine-induced hematotoxicity is warranted.
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