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Abstract
Human parvovirus B19 infection could be manifested as pure red cell aplasia or chronic anemia in immunocompromised host. The patient was 35-year-old female who had been diagnosed as non-Hodgkin lymphoma, peripheral T-cell unspecified type and had been performed chemotherapy. She complained headache and dizziness that was found to a marked drop in hemoglobin (3.2g/dL). A bone marrow aspiration revealed findings consistent with erythroid hypoplasia with maturation arrest. Serum parvovirus B19 PCR and anti parvovirus B19 IgM were positive. After immunoglobulin therapy, it was leading to a marked increase in reticulocyte count and corresponding rise in hemoglobin. To our knowledge, this is the first report to use immunoglobulin in an adult cancer patient with pure red-cell aplasia. Human parvovirus B19 infection should be considered in immunocompromised cancer patients with red cell aplasia and early use of immunoglobulins would be helpful in resolution of anemia and not to delay planned chemotherapy.
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Fig. 1
Bone marrow aspiration smear, Wright stain ×1,000 (A) and bone marrow biopsy, H & E stain ×400 (B). Erythroid precursors were markedly decreased in bone marrow aspiration and M:E ratio was 72:1. But, granulocytic precursors were normal in number and in distribution. Bone marrow biopsy shows normocellular and the cellularity was 50%. Megakaryocytes and granulocytic precursors were normal in number and distribution but erythroid precursors were hardly observed.
Fig. 2
Change of hemoglobin and reticulocyte count during hospital course. Despite of RBC transfusion in total 4 times, hemoglobin level was 6.7g/dL and reticulocyte count was 0.1%. At 39th hospital day (HD), we provided intravenous immunoglobulin (400mg/kg weekly). At 43th HD, we observed a marked increase in reticulocyte count and corresponding rise in hemoglobin. At 50th HD, hemoglobin level recovered to 9.1g/dL and reticulocyte count rose to 6.4% without transfusion.
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