Plasma exchange as an effective treatment for refractory pure red cell aplasia post-ABO-incompatible hematopoietic stem cell transplantation: a rare complication

Pure red blood cell aplasia (PRCA) is a rare complication of major ABO-incompatible hematopoietic stem cell transplantation (HSCT), characterized by severe anemia due to impaired erythropoiesis. We report the case of 52 year old man with chronic myeloid leukemia who developed refractory PRCA four months post transplant. The patient was unresponsive to multiple immunosuppressive agents but showed marked hematologic recovery following ten sessions of plasma exchange (PEX) over five weeks. Hemoglobine level rose from 6 g/Dl to 16 g/dL, eliminating the need for further transfusions. This report highlights a case of refractory PRCA successfully treated with PEX, underscoring its potential efficacy and the need for further research to establish treatment guidelines.