{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T23:01:03Z","timestamp":1775948463531,"version":"3.50.1"},"reference-count":27,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Pure red cell aplasia (PRCA) is a rare blood disorder that is characterized by severe hypo-erythroid bone marrow hypoplasia leading to severe anemia that usually does not respond to standard treatment. In patients with chronic kidney disease (CKD), especially in those patients who are erythropoiesis-stimulating agent (ESA) resistant, management can be quite difficult. In this case report, we will present a 67-year-old woman with CKD (not on dialysis) who presented with refractory anemia (hemoglobin 45\u201365\u2009g\/L) and was ultimately diagnosed with PRCA after bone marrow aspirate. This patient had previously received treatment (ESAs, iron supplementation, and multiple blood transfusions) without improvement in her blood counts. After initiation of oral Roxadustat 100\u2009mg t.i.w., her hemoglobin increased gradually and stabilized between 100 and 106\u2009g\/L, and she no longer required blood transfusions. This case report highlights the potential role of Roxadustat as a new therapeutic option for PRCA and ESA-resistant CKD. While these data are encouraging, larger controlled studies are going to be required to evaluate measures of efficacy, dosing, and long-term safety in this population.<\/jats:p>","DOI":"10.1515\/biol-2025-1155","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T06:57:41Z","timestamp":1759561061000},"source":"Crossref","is-referenced-by-count":1,"title":["Treatment of pure red cell aplasia in a chronic kidney disease patient with roxadustat: A case report"],"prefix":"10.1515","volume":"20","author":[{"given":"Shanlin","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine , No. 39 Shi-er-Qiao Road , Chengdu , 610072, Sichuan , China"},{"name":"Department of Nephrology, Nanbu County Hospital of Traditional Chinese Medicine , Nanchong , 637300, Sichuan , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bonan","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine , No. 39 Shi-er-Qiao Road , Chengdu , 610072, Sichuan , China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuhua","family":"He","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital of Chengdu University of Traditional Chinese Medicine , No. 39 Shi-er-Qiao Road , Chengdu , 610072, Sichuan , China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2025,10,4]]},"reference":[{"key":"2025122123391946213_j_biol-2025-1155_ref_001","doi-asserted-by":"crossref","unstructured":"Means Jr RT. Pure red cell aplasia. Hematol Am Soc Hematol Educ Program. 2016;2016(1):51\u20136. 10.1182\/asheducation-2016.1.51.","DOI":"10.1182\/asheducation-2016.1.51"},{"key":"2025122123391946213_j_biol-2025-1155_ref_002","unstructured":"Kaito K, Otsubo H, Usui N, Kobayashi M. Diagnosis and treatment of pure red-cell aplasia. Blood Transfus. 2022;20(3):207\u201314. 10.2450\/2022.0173-21."},{"key":"2025122123391946213_j_biol-2025-1155_ref_003","doi-asserted-by":"crossref","unstructured":"Erslev AJ. Erythropoietin and the regulation of erythropoiesis. N Engl J Med. 1991;324(19):1339\u201344. 10.1056\/NEJM199105093241906.","DOI":"10.1056\/NEJM199105093241907"},{"key":"2025122123391946213_j_biol-2025-1155_ref_004","doi-asserted-by":"crossref","unstructured":"Brodsky RA. How I treat acquired pure red cell aplasia. Blood. 2021;137(15):1991\u20138. 10.1182\/blood.2020008394.","DOI":"10.1182\/blood.2021010898"},{"key":"2025122123391946213_j_biol-2025-1155_ref_005","doi-asserted-by":"crossref","unstructured":"Sawada K, Fujishima N, Hirokawa M. Acquired pure red cell aplasia: updated review of treatment. Br J Haematol. 2008;142(4):505\u201314. 10.1111\/j.1365-2141.2008.07217.x.","DOI":"10.1111\/j.1365-2141.2008.07216.x"},{"key":"2025122123391946213_j_biol-2025-1155_ref_006","unstructured":"Maekawa T, Tanaka T, Kameoka J. Splenectomy as a treatment for pure red cell aplasia: a case series and literature review. Int J Hematol. 2020;111(1):93\u2013101. 10.1007\/s12185-019-02764-8."},{"key":"2025122123391946213_j_biol-2025-1155_ref_007","doi-asserted-by":"crossref","unstructured":"Cazzola M, Malcovati L. Myelodysplastic syndromes\u2014coping with ineffective hematopoiesis. N Engl J Med. 2005;352(6):536\u20138. 10.1056\/NEJMcibr045502.","DOI":"10.1056\/NEJMp048266"},{"key":"2025122123391946213_j_biol-2025-1155_ref_008","doi-asserted-by":"crossref","unstructured":"Kumari R, Tiwari S, Atlani M, Anirudhan A, Goel SK, Kumar A. Association of single nucleotide polymorphisms in KCNA10 and SLC13A3 genes with the susceptibility to chronic kidney disease of unknown etiology in central indian patients. Biochem Genet. 2023;61(4):1548\u201366. 10.1007\/s10528-023-10335-7.","DOI":"10.1007\/s10528-023-10335-7"},{"key":"2025122123391946213_j_biol-2025-1155_ref_009","doi-asserted-by":"crossref","unstructured":"Locatelli F, Fishbane S, Block GA, Macdougall IC. Targeting hypoxia-inducible factors for the treatment of anemia in chronic kidney disease patients. Am J Nephrol. 2017;45(3):187\u201399. 10.1159\/000455382.","DOI":"10.1159\/000455166"},{"key":"2025122123391946213_j_biol-2025-1155_ref_010","unstructured":"Chaparro JA, Kazmi I, Hesson A, Gupta V. Roxadustat: an emerging treatment for anemia associated with chronic kidney disease. J Clin Pharm Ther. 2021;46(4):898\u2013906. 10.1111\/jcpt.13360."},{"key":"2025122123391946213_j_biol-2025-1155_ref_011","doi-asserted-by":"crossref","unstructured":"Lobbes H. L\u2019\u00e9rythroblastop\u00e9nie: diagnostic, classification, traitement [pure red cell aplasia: diagnosis, classification and treatment]. Rev Med Internet. 2023 Jan;44(1):19\u201326. 10.1016\/j.revmed.2022.10.385. Epub 2022 Nov 3. PMID: 36336519.","DOI":"10.1016\/j.revmed.2022.10.385"},{"key":"2025122123391946213_j_biol-2025-1155_ref_012","doi-asserted-by":"crossref","unstructured":"Heras-Benito M. Renal anemia: current treatments and emerging molecules. Rev Clin Esp. 2023 Aug\u2013Sep;223(7):433\u20139. 10.1016\/j.rceng.2 023.06.006. Epub 2023 Jun 20. PMID: 37348652.","DOI":"10.1016\/j.rceng.2023.06.006"},{"key":"2025122123391946213_j_biol-2025-1155_ref_013","doi-asserted-by":"crossref","unstructured":"Alfaraj M, Saeed HA. Pure red cell aplasia is a disease of great diversity. J Appl Hematol. 2020;11(1):1. 10.4103\/joah.joah_63_19.","DOI":"10.4103\/joah.joah_63_19"},{"key":"2025122123391946213_j_biol-2025-1155_ref_014","unstructured":"Red Blood Cell Disease (Anemia) Group, Chinese Society of Hematology, Chinese Medical Association. [Chinese expert consensus on the diagnosis and treatment of acquired pure red cell aplasia (2020)]. Zhonghua Xue Ye Xue Za Zhi. 2020 Mar;41(3):177\u201384. doi: 10.3760\/cma.j.issn.02532727.2020.03.001."},{"key":"2025122123391946213_j_biol-2025-1155_ref_015","unstructured":"Yali D. In vitro exploratory study on the clinical efficacy of sirolimus in the treatment of refractory pure red cell aplastic anemia and its mechanism of action [D]. Beijing, China: Peking Union Medical College; 2017."},{"key":"2025122123391946213_j_biol-2025-1155_ref_016","unstructured":"Red cell diseases (anemia) Group, Society of Hematology. Chinese Medical Association. Chinese expert consensus on the diagnosis and treatment of acquired pure red cell aplasia. Chin J Hematol. 2020;41(3):177\u201384. 10.3760\/cma.j.issn.0253 2727.2020.03.001."},{"key":"2025122123391946213_j_biol-2025-1155_ref_017","doi-asserted-by":"crossref","unstructured":"Chen Z, Liu X, Chen M, Yang C, Han B. Successful sirolimus treatment of patients with pure red cell aplasia complicated with renal insufficiency. Ann Hematol. 2020 Apr;99(4):737\u201341.","DOI":"10.1007\/s00277-020-03946-2"},{"key":"2025122123391946213_j_biol-2025-1155_ref_018","doi-asserted-by":"crossref","unstructured":"Brown TJ, Mamtani R, Bange EM. Immunotherapy adverse effects. JAMA Oncol. 2021 Dec;7(12):1908. 10.1001\/jamaoncol.2021.5009.","DOI":"10.1001\/jamaoncol.2021.5009"},{"key":"2025122123391946213_j_biol-2025-1155_ref_019","doi-asserted-by":"crossref","unstructured":"Swinson B, Waters PS, Webber L, Nathanson L, Cavallucci DJ, O\u2019Rourke N, et al. Portal vein thrombosis following elective laparoscopic splenectomy:incidence and analysis of risk factors. Surg Endosc. 2022 May;36(5):3332\u20139. 10.1007\/s00464-021-08649-x.","DOI":"10.1007\/s00464-021-08649-x"},{"key":"2025122123391946213_j_biol-2025-1155_ref_020","doi-asserted-by":"crossref","unstructured":"Xavier RD, Devaraj S, Sadasivam V, Prakasam O, Menon N, Hariharan A, et al. Thymoma associated with pure red cell aplasia: a case report and literature review.Indian. J Thorac Cardiovasc Surg. 2020 Jul;36(4):404\u20138. 10.1007\/s12055-019-00875-2.Epub.","DOI":"10.1007\/s12055-019-00875-2"},{"key":"2025122123391946213_j_biol-2025-1155_ref_021","doi-asserted-by":"crossref","unstructured":"Taher AT, Weatherall DJ, Cappellini MD. Thalassaemia. Lancet. 2018 Jan;391(10116):155\u201367. 10.1016\/S0140-6736(17)31822-6.","DOI":"10.1016\/S0140-6736(17)31822-6"},{"key":"2025122123391946213_j_biol-2025-1155_ref_022","doi-asserted-by":"crossref","unstructured":"Parisi S, Finelli C, Fazio A, De Stefano A, Mongiorgi S, Ratti S, et al. Clinical and molecular insights in erythropoiesis regulation of signal transduction pathways in myelodysplastic syndromes and \u03b2-thalassemia. Int J Mol Sci. 2021 Jan;22(2):827. 10.3390\/ijms22020827.","DOI":"10.3390\/ijms22020827"},{"key":"2025122123391946213_j_biol-2025-1155_ref_023","unstructured":"Zheng G, Chang X, Gao W, Xue H. A case of uremia combined with pure erythrocyte aplastic anemia treated with roxarestat combined with immunosuppressant. Chin J Nephrol. 2021;37(1):57\u20138. 10.3760\/cma.j.cn441217-20200429-00011."},{"key":"2025122123391946213_j_biol-2025-1155_ref_024","unstructured":"Fu J, Qin Z, Yang W, Meng L, Wang S. Roxarestat for the treatment of a case of aplastic anaemia in dialysis patients with chronic kidney disease combined with pure red blood cells. J Clin Nephrol. 2023;23(7):613\u20136.  10.3969\/j.issn.1671-2390.2023.07.015."},{"key":"2025122123391946213_j_biol-2025-1155_ref_025","doi-asserted-by":"crossref","unstructured":"Wan K, Yin Y, Luo Z, Cheng J. The remarkable response to roxadustat in a case of anti-erythropoietin antibody-mediated pure red cell aplasia. Ann Hematol. 2021;100(2):591\u20133. 10. 1007\/s00277-020-04269-y.","DOI":"10.1007\/s00277-020-04269-y"},{"key":"2025122123391946213_j_biol-2025-1155_ref_026","doi-asserted-by":"crossref","unstructured":"Zhao XN, Liu SX, Wang ZZ, Zhang S, You LL. Roxadustat alleviates the inflammatory status in patients receiving maintenance hemodialysis with erythropoiesis-stimulating agent resistance by increasing the short-chain fatty acids producing gut bacteria. Eur J Med Res. 2023;28(1):230. 10.1186\/s40001-023-01179-3.","DOI":"10.1186\/s40001-023-01179-3"},{"key":"2025122123391946213_j_biol-2025-1155_ref_027","doi-asserted-by":"crossref","unstructured":"Liu J, Zhou K, Meng C, Liu Z, Huang R, Waheed Y, et al. Roxadustat effectiveness versus ESAs in peritoneal dialysis patients during the COVID-19 pandemic: A retrospective study. PLoS One. 2025;20(3):e0320536. 10.1371\/journal.pone.0320536.","DOI":"10.1371\/journal.pone.0320536"}],"container-title":["Open Life Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/biol-2025-1155\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/biol-2025-1155\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T23:43:18Z","timestamp":1766360598000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/biol-2025-1155\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,1]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,3,7]]},"published-print":{"date-parts":[[2025,3,7]]}},"alternative-id":["10.1515\/biol-2025-1155"],"URL":"https:\/\/doi.org\/10.1515\/biol-2025-1155","relation":{},"ISSN":["2391-5412"],"issn-type":[{"value":"2391-5412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,1]]},"article-number":"20251155"}}