A case of parvovirus B19-induced pure red cell aplasia in a child following heart transplant

Abstract

We describe a case of an 11-year-old boy who underwent orthotopic heart transplant for dilated cardiomyopathy. He developed a normocytic, normochromic anaemia with a low reticulocyte count 1 month after transplant. A bone marrow biopsy was performed, which showed a mildly hypocellular bone marrow with few red blood cell precursors with giant pro-erythroblasts indicative of a pure red cell aplasia. Parvovirus B19 polymerase chain reaction in the blood was positive 2 months after transplant. Intravenous immunoglobulin administration resulted in a resolution of the anaemia over several months. Unexplained pure red cell aplasia in immunosuppressed patients should alert one to the possibility of parvovirus B19 infection.

Human parvovirus B19 frequency among blood donors after an epidemic outbreak: relevance of the epidemiological scenario for transfusion medicine

“…Direct transfusion of B19V-containing blood and blood components can infect a susceptible receptor. In this situation, transfusion transmission is associated to risk of anemia, particularly in vulnerable recipients (non-immune pregnant women and immunosuppressed/ transplant patients) in whom different moderate to severe diseases can occur after B19V-induced depletion of erythrocyte precursors [50,51,52,53]. Even when blood units from B19V viremic donors from our study might have been used for transfusion, reception of more than one blood unit dilute the virus and also passively immunize with neutralizing antibodies.…”

Pure red cell aplasia caused by parvovirus B19 in a heart transplant recipient

“…Pure red cell aplasia caused by parvovirus B19 infection is a rare but clinically important complication that may arise in the period after transplantation . The diagnosis can be suspected on the basis of a careful examination of the bone marrow, showing pathognomonic morphological features of early erythroblasts.…”

Parvovirus B19‐induced severe anemia in heart transplant recipients: Case report and review of the literature

“…6 Since then only 15 additional heart transplant patients (including this case report) have been reported to have developed anemia, including transfusion-dependent anemia secondary to B19V. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] References from all of the articles were examined for additional cases (Table 1). Clinical characteristics, immunosuppressive regimens, laboratory findings, diagnostic testing, B19V therapy and outcomes, including our case, are presented in Table 1.…”

“…The first case of anemia secondary to B19V in a heart transplant patient was reported in 1993 . Since then only 15 additional heart transplant patients (including this case report) have been reported to have developed anemia, including transfusion‐dependent anemia secondary to B19V . References from all of the articles were examined for additional cases (Table ).…”