Human Parvovirus B19 Induced Pure Red Cell Aplasia in a Known Case of Hereditary Spherocytosis; A Bone Marrow Diagnosis
Abstract
Human Parvovirus B19 (HPV B19) is a single stranded DNA virus belonging to parvoviridae family causing an acute self-limiting viral infection transmitted through respiratory droplets. However, in patients with hemolytic anemia, it can cause pure red cell aplasia and eventually aplastic crisis. We report a case of 27-year-old male, who presented with complaints of fever, nausea and body ache for 15 days. Physical examination showed pallor, icterus and splenomegaly. Complete blood count (CBC) revealed pancytopenia. Plasmodium Vivax infection was seen on peripheral blood smear (PBS) and hence was treated with antimalarials, however fever persisted. Bone marrow examination done in view of panytopenia revealed large proerythroblast with eosinophilic intranuclear inclusions. The impression given was hypercellular marrow with erythroblastopenia with parvoviral inclusions. Parvovirus B19 quantitative PCR showed elevated titers. He is also a diagnosed case of Hereditary Spherocytosis and Gilberts syndrome since 2015. Acute onset pancytopenia in individuals suffering from chronic hemolytic anemias should raise a suspicion of viral infection. Timely diagnosis and supportive management is vital.References
Means Robert T Jr. Pure red cell aplasia. Blood. 2016. 128(21). 2504-2509.
Serjeant BE, Hambleton IR, Kerr S, Kilty CG, Serjeant GR. Haematological response to parvovirus B19 infection in homozygous sickle-cell disease. Lancet. 2001 Nov 24;358(9295):1779-80
3.Bain Barbara J, Clark David M, Wilkins Bridget S. Erythropoeisis, Granulopoeisis , thrombopoiesis. Bone Marrow Pathology. Fifth edition. ,Wiley- Blackwell. 2019 February. 558-63
Penchansky Land Jordan JA(1997) Transient erythroblastopeina of childhood associated with human herpes virus type 6, variant B, Am J Clin Pathol, 108, 127-132.
Remo Leisi, Chiarina Di Tommaso,Christopher Kempf, Carlos Ros, The receptor binding domain in the VP1u region of Parvovirus B19; Viruses ; 8(3)-61
Heegaard ED, Brown KE. Human parvovirus B19. Clin Microbiol Rev 2002; 15: 485-505.
Fisch P, Handgretinger R, Schaefer HE. Pure red cell aplasia. Br J Haematol.2000; 111: 1010-22.
Green DH, Bellingham AJ, Anderson MJ. Parvovirus infection in a family associated with aplastic crisis in an affected sibling pair with hereditary spherocytosis. J Clin Pathol. 1984 Oct;37(10):1144-6.
Balaji M. D., Vadlamudy Vinay*, Shankar Vangalpudi V. Aplastic crisis in a child with hereditary spherocytosis with a strong family history resolving with supportive care. nt J Contemp Pediatr. 2018 May;5(3):1150-1152.
Jordan JA. Diagnosing human parvovirus B19 infection: guidelines for test selection. Mol Diagn. 2001 Dec;6(4):307-12.
Copyright (c) 2023 Tejaswini Priyadarshan Waghmare, Meera T P, Daksha Piyush Prabhat, Ankita Asthana
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
