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Korean J Lab Med. 2010 Dec;30(6):591-594. Korean.
Published online December 02, 2010.  https://doi.org/10.3343/kjlm.2010.30.6.591
Copyright © 2010 The Korean Society for Laboratory Medicine
Parvovirus B19-induced Pure Red Cell Aplasia in a Liver Transplant Recipient
Eun Young Lee, M.D., Yonggeun Cho, M.D., Sang-Guk Lee, M.D. and Jaewoo Song, M.D.
Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Jaewoo Song, M.D. Department of Laboratory Medicine, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul 120-752, Korea. Tel: +82-2-2228-6128, Fax: +82-2-313-0956, Email: labdx@yuhs.ac
Received April 29, 2010; Revised August 14, 2010; Accepted October 11, 2010.

Abstract

Parvovirus B19 infection is known to cause chronic anemia in immunocompromised hosts, including organ transplant recipients. We report the first case of liver transplant recipient with parvovirus B19-induced pure red cell aplasia in Korea. A 57-yr-old female patient with hepatocellular carcinoma due to hepatitis C virus received a liver transplantation. Two months later, anemia developed and she received periodic red blood cell transfusions. However, chronic anemia persisted and bone marrow examination was performed 8 months after transplantation. Bone marrow aspiration smears showed markedly reduced erythroid precursors with atypical giant pronormoblasts and nuclear remnants with viral inclusions, and characteristic lantern cells were observed in biopsy sections. In addition, parvovirus B19 DNA PCR was positive. She was diagnosed as parvovirus B19-induced pure red cell aplasia and her anemia was improved following intravenous immunoglobulin therapy.

Keywords: Pure red cell aplasia; Parvovirus B19; Human; Liver transplantation

Figures


 Fig. 1
Bone marrow aspiration smears reveal abnormal giant pronormoblasts with intranuclear inclusion bodies (Wright-Giemsa stain, ×1,000). The bold arrow denotes an abnormal giant pronormoblast and the single arrow denotes an intranuclear inclusion body.
Click for larger image


Fig. 2
An abnormal giant erythroblast with glassy, eosinophilic, intranuclear inclusion and a clear central halo (lantern cell) (H&E stain, ×1,000). The bold arrow denotes an abnormal giant erythroblast and the single arrow denotes an intranuclear inclusion.
Click for larger image


Fig. 3
Parvovirus B19 quantitative PCR. Viral load in the patient was 2.96×107 IU/mL.
Click for larger image

References
1. Cossart YE, Field AM, Cant B, Widdows D. Parvovirus-like particles in human sera. Lancet 1975;1:72–73.
2. Santagostino E, Mannucci PM, Gringeri A, Azzi A, Morfini M. Eliminating parvovirus B19 from blood products. Lancet 1994;343:798.
3. Anderson LJ. Human parvoviruses. J Infect Dis 1990;161:603–608.
4. Lee YJ, So BJ, Chae KM, Jeong BH. A case of pure red cell aplasia due to parvovirus B19 in renal transplantation. Korean J Hematol 1999;34:646–650.
5. Setúbal S, de Oliveira SA, Pires AR, da Fonseca EC, Camacho LA, Seródio AC, et al. Erythrovirus B19 infection in acquired immunodeficiency syndrome: screening by histopathology, immunohistochemistry, and in situ hybridization. Mem Inst Oswaldo Cruz 2006;101:407–414.
6. Kerr JR, Curran MD, Moore JE, Coyle PV, Ferguson WP. Persistent parvovirus B19 infection. Lancet 1995;345:1118.
7. Musiani M, Zerbini M, Gentilomi G, Plazzi M, Gallinella G, Venturoli S. Parvovirus B19 clearance from peripheral blood after acute infection. J Infect Dis 1995;172:1360–1363.
8. 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 infection and its cure with immunoglobulin therapy. N Engl J Med 1989;321:519–523.
9. Ramage JK, Hale A, Gane E, Cohen B, Boyle M, Mufti G, et al. Parvovirus B19-induced red cell aplasia treated with plasmapheresis and immunoglobulin. Lancet 1994;343:667–668.
10. Chang FY, Singh N, Gayowski T, Marino IR. Parvovirus B19 infection in a liver transplant recipient: case report and review in organ transplant recipients. Clin Transplant 1996;10:243–247.
11. Misra S, Moore TB, Ament ME, Busuttil RW, McDiarmid SV. Red cell aplasia in children on tacrolimus after liver transplantation. Transplantation 1998;65:575–577.
12. Liang TB, Li DL, Yu J, Bai XL, Liang L, Xu SG, et al. Pure red cell aplasia due to parvovirus B19 infection after liver transplantation: a case report and review of the literature. World J Gastroenterol 2007;13:2007–2010.
13. Nour B, Green M, Michaels M, Reyes J, Tzakis A, Gartner JC, et al. Parvovirus B19 infection in pediatric transplant patients. Transplantation 1993;56:835–838.
14. Gallinella G, Manaresi E, Venturoli S, Grazi GL, Musiani M, Zerbini M. Occurrence and clinical role of active parvovirus B19 infection in transplant recipients. Eur J Clin Microbiol Infect Dis 1999;18:811–813.
15. Ndimbie OK, Frezza E, Jordan JA, Koch W, van Thiel DH. Parvovirus B19 in anemic liver transplant recipients. Clin Diagn Lab Immunol 1996;3:756–760.
16. Florea AV, Ionescu DN, Melhem MF. Parvovirus B19 infection in the immunocompromised host. Arch Pathol Lab Med 2007;131:799–804.
17. Wong TY, Chan PK, Leung CB, Szeto CC, Tam JS, Li PK. Parvovirus B19 infection causing red cell aplasia in renal transplantation on tacrolimus. Am J Kidney Dis 1999;34:1132–1136.
18. Geetha D, Zachary JB, Baldado HM, Kronz JD, Kraus ES. Pure red cell aplasia caused by Parvovirus B19 infection in solid organ transplant recipients: a case report and review of literature. Clin Transplant 2000;14:586–591.
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