Response of Diamond-Blackfan anemia to metoclopramide: evidence for a role for prolactin in erythropoiesis

Author:

Abkowitz Janis L.1,Schaison Gerard1,Boulad Farid1,Brown Deborah L.1,Buchanan George R.1,Johnson Christine A.1,Murray Jeffrey C.1,Sabo Kathleen M.1

Affiliation:

1. From the Division of Hematology, Department of Medicine, University of Washington, Seattle; Pediatric Service Hospital St Louis, Paris, France; Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY; Children's Memorial Hospital, Chicago, IL; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas; Department of Pediatrics, Wake Forest University, Winston-Salem, NC; and Cook Children's Medical Center, Fort Worth, TX.

Abstract

A 47-year-old woman with severe macrocytic anemia markedly improved during the second and third trimesters of 3 pregnancies and when breast-feeding her 2 children. Because the serum prolactin level is elevated at these times, we later treated her with metoclopramide (10 mg orally 3 times daily), a medication known to induce prolactin release. Her serum prolactin levels increased from 7 to 133 ng/mL (normal < 20 ng/mL) and hematocrit from 17% to 22% to 35%. With continued therapy (now 10 mg orally daily), her hematocrit has ranged from 30% to 40% for 6 years, although the macrocytosis persists (mean corpuscular volume, 100-112 fL). On the basis of this observation, a pilot study was undertaken of metoclopramide therapy in patients with Diamond-Blackfan anemia who were refractory to low doses of corticosteroids. Fifteen patients were enrolled and 9 completed the planned 16 weeks of therapy. Three individuals responded, suggesting that this therapeutic approach may benefit others. As with the index case, the anemia did not improve until 12 to 15 weeks of therapy had been completed.

Publisher

American Society of Hematology

Subject

Cell Biology,Hematology,Immunology,Biochemistry

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