乳腺癌患者手术联合化疗后网织红细胞相关参数的动态监测及临床意义

目的探讨网织红细胞计数(RET)、网织红细胞分类(高荧光强度网织红细胞百分率(HFR%)、中荧光强度网织红细胞百分率(MFR%)、低荧光强度网织红细胞(LFR%)和未成熟网织红细胞指数(IRF)等参数在乳腺癌患者手术联合化疗后不同阶段的变化,及其在患者化疗后监测骨髓造血功能的临床价值。方法 2013年1月至2013年12月该院乳腺科收治的68例乳腺癌患者,行乳房广泛切除或象限切除后,采用AT、CMF或FAC化疗方案,在化疗前和化疗后第3、7、14、21、28天抽取外周血分别检测RET、HFR、MFR和IRF,观察各项指标在不同阶段的动态变化。结果乳腺癌患者在化疗后第3天外周血RET、HFR、MFR和IRF即出现降低,RET、HFR和MFR持续降低至第14天后开始升高,IRF持续降低至化疗后第7天,随后开始升高。外周血WBC从化疗后第3天持续最低至第21天,随后逐渐缓慢升高。结论 RET、HFR、MFR、IRF各参数可以反映手术联合化疗治疗的乳腺癌患者化疗后骨髓造血功能的抑制和开始恢复情况,IRF升高较其他参数出现更早,是造血功能早期恢复的敏感指标,具有重要的临床价值。     

体外循环心脏手术后不成熟网织红细胞变化及意义

使用日本Sysmex-2100型血液分析仪的流式细胞技术和荧光核酸染色技术测定107例心脏手术患者手术前后血红蛋白（HGB）、网织红细胞（RET）、低荧光强度网织红细胞（LFR）、中荧光强度网织红细胞（MFR）、高荧光强度网织红细胞（HFR）、不成熟网织红细胞（IRF）变化规律。结果IRF在手术结束时就升高，在术后第1天就显著高于术前水平，在术后第5～9天达高峰。网织红细胞5项参数间呈正相关。提示心脏术后机体处于缺血缺氧状态。IRF比HGB和RET能更早的反映骨髓红系的造血情况，心脏术后监测IRF的演变趋势有利于判断患者病情和指导治疗。     

BMI、NLR、PLR以及网织红细胞系列指标与肥胖合并OSAHS患者病情的相关性分析

目的探讨体质量指数(BMI)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、网织红细胞绝对值(RET)、未成熟网织红细胞指数(IRF)等临床资料与肥胖合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者病情严重程度的相关性,以期发现筛查肥胖患者减重代谢手术术前是否合并OSAHS的敏感指标。方法采用回顾性病例对照研究,将70名受试者根据呼吸暂停低通气指数(apnea-hypopnea index,AHI)分为四组。比较各组BMI、NLR、PLR、RET、IRF等临床资料,分析探讨上述指标与肥胖合并OSAHS患者病情严重程度的相关性。结果中重度OSAHS组患者BMI明显高于轻度及非OSAHS组,而重度组平均指脉氧饱和度(MSpO2)及最低指脉氧饱和度(LSaO2)均显著低于轻度及非OSAHS组,重度OSAHS组NLR、RET以及IRF均高于非OSAHS组,差异均具有统计学意义(P<0.05)。Logistic回归分析发现OSAHS独立预测变量为BMI、IRF,受试者工作特征曲线(ROC)分析,显示曲线下面积(AUC)分别为0.792、0.810,联合诊断AUC为0.897,敏感度为71.7%,特异度为100%。结论BMI、IRF、NLR以及RET均与肥胖合并OSAHS患者病情严重程度密切相关,而BMI和IRF两者联合诊断可用于减重代谢手术术前OSAHS的初步筛查以及患者病情严重程度的评估。     

老年地中海贫血患者网织红细胞参数的变化

目的探讨地中海贫血(地贫)老年患者网织红细胞百分率(RET%)、网织红细胞绝对值(RET#)、未成熟网织红细胞比率(IRF)、低荧光强度网织红细胞百分率(LFR)、中荧光强度网织红细胞百分率(MFR)、高荧光强度网织红细胞百分率(HFR)6项参数的变化情况。方法用Sysmex XE-2100全自动血细胞分析仪测定34例老年地贫患者网织红细胞6项参数,进行老年地贫与正常老年人之间的比较,与α、β地贫之间的比较,与非老年地贫的比较。结果老年地贫患者IRF、MFR、HFR均较正常老年人高,LFR均较正常老年人低。老年男性地贫与非老年地嵌网织红细胞各项参数无明显差别。老年女性α地贫患者IRF、MFR、HFR高于β地贫,LFR低于β地贫;老年女性β地贫RET%、RET#、IRF、MFR、HFR 5项参数均低于非老年β地贫,LFR高于非老年β地贫。结论观察老年地贫患者网织红细胞IRF、LFR、MFR、HFR4项参数较传统观察RET%、RET#2项参数更有意义。女性老年α地贫患者骨髓反应较β地贫强,女性老年地贫患者骨髓造血功能低于女性非老年地贫。     

网织红细胞参数在慢性肾脏病贫血患者诊治中的应用

目的 探讨慢性肾脏病患者中网织红细胞不成熟指数(IRF)的变化及临床意义.方法 收集该院肾内科2010年10月至2012年3月收治的慢性肾脏病患者66例,分为贫血组(n=40)和非贫血组(n=26).另取健康体检者30例作为正常对照.全自动血液分析仪检测IRF的变化.结果 对照组、慢性肾脏病非贫血和贫血组的血红蛋白平均水平分别为(128.92±12.43)、(122.51 ±12.06)和(72.44±11.57) g/L,贫血组显著高于非贫血组和对照组(P＜0.01).对照组、慢性肾脏病非贫血和贫血组的IRF值分别为(8.34±2.08)、(14.42±4.19)和(18.55±5.10)％,其中贫血组显著高于非贫血组(P＜0.05),而非贫血组又显著高于对照组(P＜0.05).慢性肾脏病贫血患者治疗2个月后可以检测到血红蛋白的改变(P＜0.05),但IRF在治疗1个月时就出现反应性升高(P＜0.05).结论 网织红细胞IRF参数的检测可用于肾性贫血的早期诊断以及疗效评估.     

HbH病网织红细胞三分群及IRF参数观察

目的探讨网织红细胞三分群及低荧光强度网织红细胞百分率（LFR）等4项参数在血红蛋白H病（HbH病）中的变化。方法选择HbH病患者72例,用Sysmex XE-2100血细胞分析仪测定低荧光强度网织红细胞百分率（LFR）、中荧光强度网织红细胞百分率（MFR）、高荧光强度网织红细胞百分率（HFR）三分群及未成熟网织红细胞比率（IRF）4项参数,行不同贫血程度HbH病患者间的比较。结果 HbH病患者LFR低于正常人,MFR、HFR及IRF高于正常人（P〈0.05）。中、重度贫血HbH病患者的LFR低于正常及轻度贫血者,IRF、MFR、HFR均高于正常及轻度贫血者。结论 HbH病LFR减低,且贫血程度越重LFR越低;MFR、HFR及IRF增高,且随着贫血程度的加重而增高。     

36例献血者献血后网织红细胞检测的结果分析

目的:探讨献血者献血前后外周血网织红细胞计数及分型的变化情况.方法:36例献血者于献血前即时、献血后第3、6、9、12天按网织红细胞常规方法计数和分型.结果:36例献血者献血前网织红细胞计数在0.6%～1.4%之间,均值0.91%,献血后第3、6天均值分别为2.06%、1.83%,明显高于献血前,第9天均值1.47%,半数以上恢复至正常范围,第12天均值1.04%,全部恢复至正常范围.结论:献血后可刺激骨髓造血功能,使骨髓中红细胞系统加速增殖分化,促进骨髓释放网织红细胞,使外周血网织红细胞数量明显增高.     

网织红细胞参数对儿童炎症性肠炎铁储备的评价

目的:评价不同网织红细胞参数对儿童炎症性肠炎(IBD)铁储备的判断意义。方法:选择2016-01—2018-05就诊的IBD患儿99例为试验组,再选择同期体检的健康儿童110例为对照组,对比2组红细胞分布宽度(RDW)、红细胞体积因子(RSF)、未成熟网织红细胞比例(IRF)、网织红细胞分布宽度标准差(RDWR-SD)、网织红细胞分布宽度变异系数(RDWR-CV)等网织红细胞参数的差异,同时评价不同指标与血清铁蛋白、转铁饱和度(Tsat)和血清可溶性转铁蛋白受体(sTfR)的相关性。结果:试验组99例患儿中溃疡性结肠炎(UC)42例(42.42%),Crohn病(CD)57例(57.58%)。UC组、CD组和对照组血红蛋白、红细胞平均体积(MCV)、RDW、IRF、RDWR-CV、RDWR-SD、血清铁蛋白、Tsat、sTfR、C反应蛋白(CRP)、血沉(ESR)比较差异有统计学意义(P0.05),其中UC和CD组均高于对照组(P0.05),而UC和CD组间比较差异无统计学意义(P0.05),3组RSF组间比较差异无统计学意义(P0.05);Tsat与RDW、RDWR-CV、RDWR-SD呈正相关,与RSF呈负相关(P0.05);sTfR与RDW、RDWR-CV、RDWR-SD呈负相关,与RSF呈正相关(P0.05);IDA组RDW、RDWRCV、RDWR-SD高于非IDA组,而RSF低于非IDA组(P0.05),IDA组与非IDA组IRF组间比较差异无统计学意义(P0.05)。结论:RSF、RDWR为IBD患儿贫血的诊断提供了简单、低廉的评价指标,但确切的诊断价值有待进一步研究。     

网织红细胞参数对儿童炎症性肠炎铁储备的评价

目的:评价不同网织红细胞参数对儿童炎症性肠炎(IBD)铁储备的判断意义。方法:选择2016-01—2018-05就诊的IBD患儿99例为试验组,再选择同期体检的健康儿童110例为对照组,对比2组红细胞分布宽度(RDW)、红细胞体积因子(RSF)、未成熟网织红细胞比例(IRF)、网织红细胞分布宽度标准差(RDWR-SD)、网织红细胞分布宽度变异系数(RDWR-CV)等网织红细胞参数的差异,同时评价不同指标与血清铁蛋白、转铁饱和度(Tsat)和血清可溶性转铁蛋白受体(sTfR)的相关性。结果:试验组99例患儿中溃疡性结肠炎(UC)42例(42.42%),Crohn病(CD)57例(57.58%)。UC组、CD组和对照组血红蛋白、红细胞平均体积(MCV)、RDW、IRF、RDWR-CV、RDWR-SD、血清铁蛋白、Tsat、sTfR、C反应蛋白(CRP)、血沉(ESR)比较差异有统计学意义(P0.05),其中UC和CD组均高于对照组(P0.05),而UC和CD组间比较差异无统计学意义(P0.05),3组RSF组间比较差异无统计学意义(P0.05);Tsat与RDW、RDWR-CV、RDWR-SD呈正相关,与RSF呈负相关(P0.05);sTfR与RDW、RDWR-CV、RDWR-SD呈负相关,与RSF呈正相关(P0.05);IDA组RDW、RDWRCV、RDWR-SD高于非IDA组,而RSF低于非IDA组(P0.05),IDA组与非IDA组IRF组间比较差异无统计学意义(P0.05)。结论:RSF、RDWR为IBD患儿贫血的诊断提供了简单、低廉的评价指标,但确切的诊断价值有待进一步研究。     

急性自发性脑出血患者血浆D-二聚体水平的变化及临床意义

目的　观察急性自发性脑出血患者血浆D 二聚体水平的变化规律 ,探讨血浆D 二聚体与自发性脑出血发生、发展及转归的关系及其临床意义。方法　用双抗夹心酶联免疫吸附法对 30例急性自发性脑出血患者血浆D 二聚体水平进行动态观察 (病程第 1、3、7、14及 2 1天 ) ,并与 4 0例健康人及 4 0例急性脑梗死患者进行比较。结果　急性自发性脑出血患者血浆D 二聚体水平从病程第 1天起即开始升高 ,明显高于对照组 (P <0 .0 5 ) ,至第 7天达高峰 (P <0 .0 1) ,以后又呈逐渐降低趋势。患者神经功能缺损恢复程度与病程第 7天血浆D 二聚体水平呈负相关 (P<0 .0 5 )。患者的出血量与血浆D 二聚体水平无相关性。结论　急性自发性脑出血患者的血浆D 二聚体水平明显升高 ,提示脑出血急性期可能存在纤溶活性增高倾向。     

Flow cytometric reticulocyte quantification in the evaluation of hematologic recover

Abstract: The role of flow cytometric reticulocyte (RET) counting and the immature RET fractions (IRF) in the evaluation of hematopoietic recovery following chemoradiotherapy-induced aplasia was studied. RET counts and IRF were studied using an automated flow cytometric reticulocyte counter (Sysmex R-2000) in three groups of patients: 58 patients undergoing an autologous bone marrow transplantation (ABMT group), 28 of whom received granulocyte colony-stimulating factor (G-CSF); 28 patients undergoing an allogeneic bone marrow transplantation (BMT group); and 28 patients receiving remission-induction chemotherapy for acute leukemia (CHEMO group). To evaluate the IRF the percentages of RET fractions with middle and high fluorescence reticulocyte (MFR and HFR, respectively) were used. A rising IRF (expressed as the percentage of MFR ± HFR) was the first sign of hematopoietic recovery (ABMT group, IRF 9 days versus 18 days for the absolute neutrophil count (ANC); BMT group, 15 versus 18 days; CHEMO group, 9 versus 11 days). When recovery of the ANC (>0.5 times 109/1) was compared with that of the IRF (MFR ± HFR > 5%), statistically significant differences were found in all three groups. Additionally, 93.1% of the ABMT, 92% of the BMT and 91.2% of the CHEMO recovered the IRF before the ANC. In conclusion, an elevation in the percentage of IRF is the first sign of hematologic recovery in the majority of patients receiving remission-induction chemotherapy and the first sign of engraftment in those submitted to ABMT or BMT. Serial automated flow cytometric quantitative reticulocyte counting provides a useful and early measure of erythropoiesis indicative of hematopoietic reconstitution or successful bone marrow engraftment following marrow transplantation.     

Erroneously elevated immature reticulocyte counts in leukemic patients determined using a Sysmex XE-2100 hematology analyzer

The immature reticulocyte fraction (IRF) in peripheral blood, as determined by automated reticulocyte analysis, is calculated using the sum of medium and highly fluorescent reticulocyte numbers and provides information about erythropoietic activity in bone marrow. The purpose of this study was to investigate erroneously elevated IRF in leukemic patients, as determined using a Sysmex XE-2100 hematology analyzer (Sysmex, Kobe, Japan). Normal reticulocyte scattergram patterns show regions corresponding to reticulocytes located between matured RBCs and an upper particle (UPP) region, which show a continuum of non-separated fraction. The UPP represents erythroblasts and some immature reticulocytes. As a control group, peripheral blood was taken from patients with benign hematologic diseases, and their reticulocyte scattergrams all showed a normal pattern; UPP values were all less than 100. However, the reticulocyte scattergrams of 5 of 11 leukemia patients showed abnormal patterns and displayed a gap between RBC and reticulocyte regions. Three patients showed a flag with a message such as “RET Abn Scattergram”. IRF results were elevated in these five patients, and their UPP values were above 100. For the remaining six leukemia patients with a normal reticulocyte scattergram pattern, immature reticulocytes were not markedly increased, and UPP values were less than 100. The findings of the present study demonstrate that IRF results may be erroneously elevated in leukemia patients and indicate that hematologists should examine reticulocyte scattergrams and UPP values carefully.     

Assessment of hematologic progenitor engraftment by complete reticulocyte maturation parameters after autologous and allogeneic hematopoietic stem cell transplantation

BACKGROUND AND OBJECTIVES: Hematopoietic restoration after marrow ablation is initiated by the erythroid compartment. However, the absolute microscope counts or corrected percentage of reticulocytes have proven to be poor markers of hematopoietic engraftment. Some reports have highlighted the usefulness of automatic flow cytometry methods to determine highly fluorescent reticulocytes, or mean fluorescence index. In this series of 60 hematopoietic stem cell transplants, we sought the normal kinetics throughout the post-transplant period of the following reticulocyte maturing parameters: highly fluorescent reticulocytes (RETH), immature reticulocyte fraction (IRF), mean fluorescence index (MFI) and also mean reticulocyte volume (MRV). DESIGN AND METHODS: Sixty consecutive patients undergoing allogeneic bone marrow (30 cases) and autologous mobilized stem cell transplantation (30 cases) were studied. Parameters of reticulocyte maturation were measured every other day from the beginning of the conditioning regimen until myeloid engraftment. RESULTS: Nadir values for the analyzed reticulocyte parameters were found between days +4 and +7 and thereafter, increases in these reticulocyte parameters appeared earlier than the rise in neutrophils. We considered erythroid engraftment to have occurred on the day when RETH reached 3%, IRF 10%, MFI 10 and MRV 110 fL. These cut-offs were assigned considering the 25% quartile for each parameter on the day that the myeloid engraftment occurred. The median engraftment days for RETH were +9 and +16, for IRF +9 and +13, for MFI +9 and +13 and for MRV +11 and +13 in autologous and allogeneic procedures, respectively. When compared to standard neutrophil engraftment, IRF and MFI engraftment occurred significantly earlier in all patients. Remarkably, we found a statistical correlation between the day a reticulocyte parameter reached its cut-off and the subsequent day of absolute neutrophil count (ANC) recovery for MFI after allogeneic transplants and for MRV after autologous procedures (p < 0.001 and p= 0.02, respectively). Of all the clinical parameters tested, only the number of infused CD34 cells showed a statistical influence on erythroid engraftment in autologous transplant. INTERPRETATION AND CONCLUSIONS: Early reticulocytes appear sooner than neutrophils after both autologous and allogeneic transplants, and any determined reticulocyte parameter can reliably measure this fraction. Nevertheless, our results show that MRV and MFI cut-offs are useful for determining subsequent myeloid engraftment. These findings could be relevant to decision-making in those patients with primary graft failure heralded by an absence of increasing values of MFI and MRV, indicating very low production of reticulocytes from the graft, who could, therefore, benefit from earlier rescue therapy.     

Automated analyzer evaluation of reticulocytes in bone marrow and peripheral blood of hematologic disorders

The R-3000 reticulocyte analyzer uses flow cytometry with an argon laser as its light source. This analyzer stains residual RNA with auramine O to provide a reticulocyte maturation differential. Using the R-3000, we analyzed 119 samples of bone marrow (BM) and peripheral blood (PB) from 111 patients with hematologic disorders. Parameters were reticulocytes, immature reticulocyte fraction (IRF) percentage in BM and PB, BM/PB reticulocyte ratio, and BM/PB IRF ratio. Reticulocytes and IRF percentage in BM were significantly higher than in PB (p < 0.01). There was also a good correlation between reticulocyte percentages in BM and in PB (r = 0.81). Patients were classified into a normal group (without anemia) and an anemia group. Furthermore, the anemia group was classified into three groups: group 1: cases with hematopoietic dysfunction; group 2: cases in bone marrow recovery phase after chemotherapy and hematopoietic stem cell transplantation, and hematologic disorders with bone marrow accelerative phase, and group 3: cases with ineffective hematopoiesis (myelodysplastic syndrome). The mean reticulocyte percentage of the normal group was 2.3 +/- 1.1%, which was close to the normal value in BM. The BM/PB reticulocyte ratio of group 3 was statistically higher than that of groups 1 and 2. This indicates that group 3 had ineffective erythropoiesis and that the BM/PB ratio is a useful indicator for the diagnosis of myelodysplastic syndrome.     

Utility of reticulocyte maturation parameters in the differential diagnosis of macrocytic anemias

The aim of this study was to test the clinical utility of reticulocyte maturation parameters in the differential diagnosis of macrocytic anemias. Using an automated reticulocyte counter, we analyzed immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV) and mean fluorescence index (MFI) in peripheral blood samples from healthy donors (n = 30), patients diagnosed with myelodysplastic syndromes (MDS, n = 35), with megaloblastic anemia (MA, n = 10) and with non-megaloblastic macrocytic anemias (NMMA, n = 30). Macrocytic anemias due to ineffective erythropoiesis (MA and MDS) showed reticulocytes skewed to a more immature fraction. Therefore, they have a larger volume and a greater RNA content than healthy controls. Interestingly, reticulocytes in both low and high risk MDS are significantly larger (127.3 vs. 118.3 fl, P < 0.01) and have a greater RNA content (MFI 20.5 vs. 12.9, P < 0.01 and IRF 22.5 vs. 9.1%, P < 0.01) than NMMA patients. We conclude that measurement of reticulocyte maturation parameters may be a very useful tool in the differential diagnosis of macrocytic anemia. The presence of extremely high values of IRF (>16%), MFI (>18) and MRV (>129 fl), makes the diagnosis of NMMA very unlikely. An underlying MDS should, therefore, be sought.     

Patients with pulmonary and cardiac disease show an elevated proportion of immature reticulocytes

The value of reticulocyte analysis has been largely confined to classification of anaemia. In the present study, we have investigated the value of undertaking automated fluorescent reticulocyte analysis (Abbott Cell‐Dyn 4000) in patients with pulmonary or cardiac diseases. A control group of nonanaemic (n=367) and anaemic patients (n=57) was established and thereafter compared with a group of patients with pulmonary disease (172 without anaemia, 92 with anaemia) and another group with cardiac disease (520 without anaemia, 254 with anaemia). The Hb level and reticulocyte RNA content (as measured by the immature reticulocyte fraction, IRF) of the study subjects were inversely correlated (r=–0.41). The mean IRF of nonanaemic patients with pulmonary (mean=0.331, SD=0.124) and cardiac disease (mean=0.266, SD=0.079) were both significantly higher (P < 0.05) than in control subjects (mean=0.220, SD=0.062). Nonanaemic and anaemic patients with cardiac disease both showed significantly higher (P < 0.05) reticulocyte percentage counts than the equivalent anaemic and nonanaemic controls. Each of these phenomena can all be attributed to hypoxia mediated EPO production. Our observation that 35% of patients with pulmonary disease have elevated levels of IRF, may prove useful in screening for tissue hypoxia in nonanaemic patients. Furthermore, serial monitoring of the IRF may prove valuable in observing the efficacy of therapy in these patients.     

Novel hematological parameters for the evaluation of patients with myeloproliferative neoplasms: the immature platelet and reticulocyte fractions

New automated hematology analyzers have led to the availability of novel hematological parameters, including the immature platelet fraction (IPF) and the immature reticulocyte fraction (IRF), both of potential interest in patients with myeloproliferative neoplasms (MPNs). We performed a prospective analysis of 217 patients with MPN, including 32 (15%) with essential thrombocythemia (ET), 43 (20%) with polycythemia vera (PV), and 142 (65%) with myelofibrosis (MF); the IPF and IRF were measured by the Sysmex XN analyzer. As compared to patients with ET, both a higher IPF and IRF were observed among patients with PV and MF. Factors associated with high IPF among patients with PV/ET were male sex, thrombocytopenia, and diagnosis of PV; among patients with MF, they were elevated peripheral blasts, low platelet count, JAK2 V617F mutation, and previous therapy. Factors associated with high IRF among patients with PV/ET were low hemoglobin, high reticulocyte count, and PV diagnosis; among patients with MF, they were peripheral blasts and elevated reticulocytes. The IPF and IRF represent novel parameters in patients with MPN with potential relevant clinical implications. Comparison with healthy subjects and those with secondary polycythemia is needed to confirm our preliminary findings.     

Successful treatment of idiopathic pure red cell aplasia with antithymocyte globulin]

An 18-year-old woman was admitted to our hospital because of severe anemia on October 16, 1999. Laboratory data included hemoglobin 3.5 g/dl, reticulocytes 2,200/microliter, WBC 3,500/microliter, and Plt 38.5 x 10(4)/microliter. Bone marrow aspiration showed a normocellular marrow with severe erythroid hypoplasia, suggesting a diagnosis of pure red cell aplasia. Methylprednisolone pulse therapy was started on October 20, but there was no response. Administration of cyclosporine A (CyA; 400-450 mg) was begun on November 1, but again there was no response. Antithymocyte globulin (ATG; 800 mg/day for 5 days, 15 mg/kg) was started from December 1 in addition to prednisolone (60 mg/day) and CyA (450 mg/day). On day 7 of ATG therapy, the reticulocyte count began to increase, and reached a peak of 32.6 x 10(4)/microliter on day 20. The patient's hemoglobin level started to increase on day 13, and reached 8.5 g/dl on day 27. A complete response has been maintained up to the time of writing, and the hemoglobin level was 11.9 g/dl on December 14, 2000. This is the first detailed Japanese case report of successful treatment of pure red cell aplasia using ATG.