Parvovirus B19-triggered acute hemolytic anemia and thrombocytopenia in a child with Evans syndrome
Main Article Content
Keywords
Autoimmune hemolytic anemia, Evans syndrome, parvovirus B19, red cell aplasia, thrombocytopenia
Abstract
Background: Human parvovirus B19 (HPV-B19) is the etiologic agent of erythema infectiosum, of transient aplastic crises in individuals with underlying chronic hemolytic disorders, and of chronic pure red cell aplasia in immunocompromised individuals.
Case report. We describe a 14-year-old girl with long-standing Evans syndrome, who presented with severe anemia, reticulocytopenia and thromocytopenia. A bone marrow aspirate revealed severe erythroid hypoplasia along with presence of giant pronormoblasts, while serological studies and real-time PCR of whole blood were positive for acute parvovirus B19 infection. The patient was initially managed with corticosteroids, but both cytopenias resolved only after administration of intravenous gamma globulin 0.8g/kg.
Conclusion: Acute parvovirus B19 infection should be suspected in patients with immunologic diseases, who present with reticulocytopenic hemolytic anemia and thrombocytopenia. In this setting, intravenous gamma globulin is effective for both cytopenias.
Downloads
Abstract 2823
PDF Downloads 700
HTML Downloads 304
Table 1. Downloads 0
References
2. Brown KE, Young NS. Parvoviruses and bone marrow failure. Stem Cells. 1996;14:151-163.
3. Bertrand Y, Lefrere JJ, Leverger G, Courouce AM, Feo C, Clark M, Schaison G, Soulier JP. Autoimmune haemolytic anaemia revealed by human parvovirus linked erythroblastopenia. Lancet. 1985;2:382-383.
4. Smith MA, Shah NS, Lobel JS. Parvovirus B19 associated with reticulocytopenia and chronic autoimmune hemolytic anemia. Am J Pediatr Hematol Oncol. 1989;11:167-169.
5. Chambers LA, Rauck AM. Acute transient hemolytic anemia with a positive Donath-Landsteiner test following parvovirus B19 . J Pediatr Hematol Oncol. 1996;18:178-181.
6. Nobili V, Vento S, Comparcola D, Sartorelli MR, Luciani M, Marcellini M. Autoimmune hemolytic anemia and autoimmune hepatitis associated with parvovirus B19 . Pediatr Infect Dis J. 2004;23:184-185.
7. Giovannetti G, Pauselli S, Barrella G, Neri A, Antonetti L, Gentile G, Iacobini M, Girelli G, Coluzzi S. Severe warm autoimmune haemolytic anaemia due to anti-Jk(a) autoantibody associated with Parvovirus B19 in a child. Blood Transfus. 2013;11:634-635.
8. Brown KE, Anderson SM, Young NS. Erythrocyte P antigen: cellular receptor for B19 parvovirus. Science. 1993;262:114-117.
9. Chim CS, Ma SK. Giant pronormoblasts in parvovirus-associated pure red cell aplasia. Am J Hematol. 2000;65:289.
10. Mantadakis E, Farmaki E. Natural history, pathogenesis, and treatment of Evans syndrome in children. J Pediatr Hematol Oncol. 2017;39:413-419.
11. Petz LD. A physician's guide to transfusion in autoimmune haemolytic anaemia. Br J Haematol. 2004;124:712-716.
12. Kurtzman G, Frickhofen N, Kimball J, Jenkins DW, Nienhuis AW, Young NS. Pure red-cell aplasia of 10 years' duration due to persistent parvovirus B19 and its cure with immunoglobulin therapy. N Engl J Med. 1989;321:519-523.
13. Crabol Y, Terrier B, Rozenberg F, Pestre V, Legendre C, Hermine O, Montagnier-Petrissans C, Guillevin L, Mouthon L; Groupe d'experts de l'Assistance Publique-Hôpitaux de Paris. Intravenous immunoglobulin therapy for pure red cell aplasia related to human parvovirus b19 : a retrospective study of 10 patients and review of the literature. Clin Infect Dis. 2013;56:968-977.
14. Uike N, Miyamura T, Obama K, Takahira H, Sato H, Kozuru M. Parvovirus B19-associated haemophagocytosis in Evans syndrome: aplastic crisis accompanied by severe thrombocytopenia. Br J Haematol. 1993;84:530-532.
15. Sekiguchi Y, Shimada A, Imai H, Wakabayashi M, Sugimoto K, Nakamura N, Sawada T, Komatsu N, Noguchi M. A case of recurrent autoimmune hemolytic anemia during remission associated with acute pure red cell aplasia and hemophagocytic syndrome due to human parvovirus B19 successfully treated by steroid pulse therapy with a review of the literature. Int J Clin Exp Pathol. 2014;7:2624-2635.
16. Puigví L, Baumann T, Fernández S, Castro P, Pereira A, Merino A. Massive erythrophagocytosis by peripheral monocytes and neutrophils in parvovirus-B19 autoimmune hemolytic anemia. Ann Hematol. 2017;96:881-882.
17. Heegaard ED, Rosthøj S, Petersen BL, Nielsen S, Karup Pedersen F, Hornsleth A. Role of parvovirus B19 in childhood idiopathic thrombocytopenic purpura. Acta Paediatr. 1999;88:614-617.
18. Zhang YD, Hu Q, Liu SY, Liu AG, Wang GL, Xiong H, Sun Y. Association of human parvovirus B19 and childhood idiopathic thrombocytopenic purpura: a meta analysis of Chinese literatures. Zhongguo Dang Dai Er Ke Za Zhi. 2009;11:999-1001.