Hemolytic Crisis due to Parvovirus B19 in Hereditary Spherocytosis in Two Siblings

Abstract

Hemolytic anemia due to erythrocyte membrane disorder has an important place among hereditary anemia. Hereditary spherocytosis (HS) is one of the most common of them. It is an anemia which is apparent with the spherocyte-shaped erythrocytes and is usually dominantly inherited. Erythrocytes are quickly disintegrated on the periphery because of the membrane defect. Hemolytic, aplastic and megaloblastic crises are its major complications. Human Parvovirus B19 is a virus that can lead to different clinical pictures. It may lead to erythema infection in healthy children and to the aplastic crisis and severe anemia in patients with hemolytic anemia such as hereditary spherocytosis. In this article, two siblings who were diagnosed with hereditary spherocytosis as a result of severe hemolysis induced by the Parvovirus B19 infection are presented. Two brothers, one of them was 4 years old and another one was 5 years old, were brought with jaundice and weakness complaints beginning 3 days after a febril infection period. They had marked pallor, tachycardia, and splenomegaly in the physical examination. The hemoglobin level of one of them was 4.9 gr/dL, and another one's was 2.9 gr/dL. There was a large number of spherocytes in the peripheral smear. Parvovirus B19 Ig M was positive, and their osmotic fragility was increased. It was learned from their history that their father had splenomegaly. The aplastic crisis triggered by the parvovirus B19 infection and anemia due to severe hemolysis may occur as the first symptom of the hematological diseases such as hereditary spherocytosis. Attention should be paid to family history in the early diagnosis for the appropriate follow-up of children with hereditary spherocytosis which is frequently observed in our country, and hereditary spherocytosis should also be considered in the differential diagnosis of jaundice and anemia especially in the neonatal period. In addition, we wanted to remind that parvovirus B19 may lead to serious complications in the presence of hemolytic anemia.