Pure Red Cell Aplasia After Kidney Transplantation: Parvovirus B19 Culprit or Coincidence?

Pabisiak, Krzysztof; Stępniewska, Joanna; Ciechanowski, Kazimierz

doi:10.12659/aot.913663

Cited by 9 publications

(4 citation statements)

References 54 publications

(34 reference statements)

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“…It is usually recommended to start IVIG treatment at an initial dose of 400 mg/kg for at least 5 days, which can be repeated if the infection recurs. 15,16 The second line in the management of KTR patients with PB19-related anemia is the modification of their used IS regimen. Nevertheless, there is a risk of acute rejection of kidney graft in the case of reduced immunosuppression particularly during the first year after transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Passive immunization with IVIG treatment has been shown to be effective in first‐line management of PB19‐related PRCA. It is usually recommended to start IVIG treatment at an initial dose of 400 mg/kg for at least 5 days, which can be repeated if the infection recurs 15,16 . The second line in the management of KTR patients with PB19‐related anemia is the modification of their used IS regimen.…”

Section: Discussionmentioning

confidence: 99%

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Relapsing anemia associated with parvovirus B19 infection in a kidney transplant recipient: A case report and review of the literature

Yaghoubi,

Dalil,

Tavakoli

et al. 2023

Clinical Case Reports

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Key clinical messagePB19 infection should be considered an uncommon cause of posttransplant anemia in renal transplant recipients, particularly those whose anemia is not associated with common etiologies. IVIG treatment and reduced immunosuppression could be beneficial.AbstractParvovirus B19‐associated relapsing anemia is rare in kidney transplant recipients. Herein, we report a case of relapsed anemia due to parvovirus B19 infection in a 53‐year‐old woman 18 months after kidney transplantation. The patient presented with palpitations, shortness of breath, dizziness, weakness, and lethargy. Early laboratory findings showed a WBC count of 6.000/μL, RBC count of 1.89/μL, hemoglobin (Hb) 3.5 g/dL, hematocrit (Hct) 15%, platelet count 266.000/μL, MCV 89, reticulocyte count 0.8%, and serum iron 221 μg/dL. Upon further evaluation, the RT‐PCR test for BK polyomavirus and cytomegalovirus (CMV) was negative, while the parvovirus B19 RT‐PCR was positive. The patient was treated with blood transfusion and IVIG 25 g daily for 5 days. Two months after discharge, the patient presented, complaining of palpitation, shortness of breath, and dizziness, with RBC 2.7/μL, Hb 6.5 g/dL, Hct 25%, and MCV 85. Again, the CMV RT‐PCR was negative, while the parvovirus B19 RT‐PCR was positive. Tacrolimus and mycophenolic acid were stopped, and IVIG 25 g daily for 5 days was administered. Consequently, her Hb level increased to 9 g/dL, and the patient was discharged with prednisolone 5 mg daily and cyclosporine 50 mg daily instead of tacrolimus. Viral infection, particularly PB19 infection, should be considered in the differential diagnosis of posttransplantation anemia in KTRs. IVIG treatment and modification of immunosuppressive medications are suggested standard therapies for such patients. The function of transplanted kidneys should be carefully monitored during treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Relapsing anemia associated with parvovirus B19 infection in a kidney transplant recipient: A case report and review of the literature

Yaghoubi,

Dalil,

Tavakoli

et al. 2023

Clinical Case Reports

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“…Common predisposing factors for post-transplant anemia are immunosuppressive drugs and an increased risk of opportunistic infection [ 1 ]. Other contributing factors include blood loss, iron and folate deficiency, low erythropoietin, persistent hyperparathyroidism, and post-transplant medication [ 3 ]. Pure red cell aplasia (PRCA) is defined as the failure of erythropoiesis with preserved granulopoiesis and megakaryopoiesis.…”

Section: Introductionmentioning

confidence: 99%

“…Patients often present with refractory normocytic normochromic anemia with a low reticulocyte count and, in some instances, thrombotic microangiopathy. The diagnostic criteria for PRCA are normocytic anemia with less than 0.1% reticulocytes in the peripheral blood as well as less than 5% erythroblasts, giant pronormoblasts, normal megakaryopoiesis, and granulopoiesis in the bone marrow [ 3 ]. Parvovirus B19 (PVB19) infection can cause PRCA in children and immunocompromised patients, especially in kidney transplant patients.…”

Section: Introductionmentioning

confidence: 99%

Recurrent parvovirus B19 infection-associated pure red cell aplasia in a kidney transplant patient

Gang

Park

Hong

et al. 2020

Korean Journal of Transplantation

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Posttransplant anemia is a common complication after kidney transplantation. Parvovirus B19 (PVB19) infection can induce pure red cell aplasia (PRCA) in immunosuppressed transplant patients. We herein report a case of recurrent PVB19-associated PRCA in a kidney transplant patient. A 49-year-old woman presented with anemia and normal renal function 1 year after a deceased-donor kidney transplantation for immunoglobulin A nephropathy-related end-stage renal disease. She received desensitization therapy, and 2 years later, she underwent transplantation with thymoglobulin induction. Despite repeated red cell transfusion and erythropoietin therapy, her anemia aggravated progressively. Bone marrow biopsy revealed normocytic normochromic PRCA. Real-time polymerase chain reaction detected a high plasma load of PVB19. Administration of intravenous immunoglobulin (IVIG) at 2 g/kg with adjuvant reduction of tacrolimus and discontinuation of myfortic acid effectively treated the anemia. However, the PVB19 load remained high, and PRCA recurred 7 months after the initial IVIG treatment. Tacrolimus was switched to cyclosporine in the second IVIG treatment, which successfully improved PRCA and reduced the PVB19 load. Our case suggested that PVB19-associated PRCA should be suspected when persistent anemia is observed in kidney transplant patients with heavy immunosuppression and that PVB19-associated PRCA can recur in the presence of persistent PVB19 viremia.

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Ciclosporin/mycophenolate mofetil/tacrolimus

2019

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Pure Red Cell Aplasia After Kidney Transplantation: Parvovirus B19 Culprit or Coincidence?

Cited by 9 publications

References 54 publications

Relapsing anemia associated with parvovirus B19 infection in a kidney transplant recipient: A case report and review of the literature

Relapsing anemia associated with parvovirus B19 infection in a kidney transplant recipient: A case report and review of the literature

Recurrent parvovirus B19 infection-associated pure red cell aplasia in a kidney transplant patient

Ciclosporin/mycophenolate mofetil/tacrolimus

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