移植肾失功血液透析患者合并纯红细胞再生障碍性贫血治疗1例

Treatment of Pure Red-Cell Aplasia in a Hemodialysis Patient with Renal Transplantation Failure

目的:探讨肾移植术后合并纯红细胞再生障碍性贫血(Pure red cell aplasia, PRCA)的治疗策略。方法:通过1例肾移植术后发生PRCA的病例的回顾性分析。45岁女性1例,肾移植术后3月出现难治性贫血,骨髓穿刺病理提示纯红细胞再生障碍性贫血,经过调整免疫抑制剂、抗病毒治疗、补充重组人促红素(EPO)等治疗贫血无改善,需要反复输血。移植肾失功后进行维持性血液透析,使用足量罗沙司他治疗。结果:经过治疗,患者的贫血得以纠正。结论:肾移植术后发生纯红细胞再生障碍性贫血,可能存在多个诱发因素,如常规治疗无效,罗沙司他可以作为肾移植术后纯红细胞再生障碍性贫血的新选择。

Objective: To explore the treatment strategies of Pure red cell aplasia (PRCA) after renal trans-plantation. Methods: A retrospective analysis of a case with PRCA after kidney transplantation. A 45-year-old female presented with refractory anemia 3 months after renal transplantation. Bone marrow puncture pathology suggested pure red cell aplastic anemia. After adjusting immunosup-pressant, antiviral therapy, supplementing recombinant human erythropoietin (EPO) and other treatments, the anemia did not improve, and repeated blood transfusion was needed. After graft failure, maintenance hemodialysis was initiated, and sufficient Roxastat was used for treatment. Results: The anemia in the patient was successfully corrected after treatment. Conclusion: Pure red cell aplasia can occur after kidney transplantation and may have multiple inducing factors. If con-ventional treatments are ineffective, ruxolitinib can be a new option for the treatment of pure red cell aplasia after kidney transplantation.