Epidemiology of human parvovirus B19 in children with sickle cell disease

Abstract

Human parvovirus (HPV) B19 causes significant morbidity and mortality in children with sickle cell disease (SCD), but little data are published about the epidemiology of HPV B19 infection and its associated complications in this patient population. In this study, prevalence and incidence rates of HPV B19 were determined in 633 patients with SCD followed at The Children's Hospital of Philadelphia between November 1996 and December 2001. Thirty percent (30%) were HPV B19 immunoglobulin G (IgG) positive at first testing, and the 70% without evidence of past HPV B19 infection were tested annually. One hundred ten patients developed evidence of HPV B19 infection for an incidence rate of 11.3 per 100 patient years. Sixty-eight episodes of HPV B19-induced transient red cell aplasia occurred with the following clinical events: fever (89.7%), pain (61.8%), acute splenic sequestration (19.1%), and acute chest syndrome (11.8%). Pain, fever, and acute splenic sequestration were more frequent events with acute HPV B19 infections compared with acute events in uninfected patients. The results of this epidemiologic study, the largest and most comprehensive to date, justify the development of HPV B19 prevention strategies to diminish the frequent and often severe complications associated with HPV B19 infections in patients with SCD.

Molecular and serological assessment of parvovirus B19 infections among sickle cell anemia patients

“…Parvovirus B19 frequently causes transient red cell aplasia (TRCA) in children with sickle cell disease [30]. Other parvovirus B19-related complications include acute splenic sequestration, hepatic sequestration, acute chest syndrome, nephrotic syndrome, meningoencephalitis, and stroke.…”

Transfusion therapy for sickle cell disease: a balancing act

“…In a single institution observational study of Parvovirus B19 -induced RBC aplasia, the median nadir hemoglobin was 4.8 gm/dL and 49 of 68 pediatric patients (72%) received a simple RBC transfusion. 31 Because the anemia associated with RBC aplasia is subacute, the patient is typically euvolemic and physiologically compensated. Therefore, RBC transfusion should be administered slowly with serial small aliquots to prevent congestive heart failure.…”

Transient parvovirus‐associated hypoplasia of multiple peripheral blood cell lines in children with chronic hemolytic anemia

“…Smith-Whitley et al [19] reported that 18% and 27% of SCD patients with parvovirus-related aplastic crisis had neutropenia or thrombocytopenia, respectively. We found, in contrast, that 65% of patients with HS or thalassemia had leukopenia or neutropenia and 71% had thrombocytopenia.…”