Erythroblastopenia and
Parvovirus B19 infection in a healthy child
Miguel A. de las Nieves López,1 Mª
Angeles Medina Perez,1 Carlos Gónzalez
Hermoso2
1Unidad de Hematología y Hemoterapia2
Unidad de Anatomía Patológica, Hospital Costa del
Sol., Marbella. Málaga, Spain.
Correspondence: 1Unidad de Hematología y
Hemoterapia, Hospital Costa del Sol., Marbella. Málaga,
Spain. Email manieves@hcs.es
We present a case of severe anemia as the only manifestation
of primary infection by Parvovirus B19 in a healthy child with
complete response to intravenous unspecific immunoglobulin
therapy. The morphology of giant promormoblasts is shown as it is
highly specificific for Parvovirus B19 infection.
An 8 year old male previously healthy child was admitted to our
Hospital because of severe normocytic anemia (hemoglobin 5 gr/dl,
VCM 78 fl) with normal peripheral WBC and platelets counts.
Initial workup of anemia disclosed absence of reticulocytes, a
negative direct antiglobulin test and normal serum levels of
ferritin and haptoglobin. Physical examination was normal except
fot pallor and an abdominal ultrasound and chest roentgenogram
disclosed no abnormalities. Bone marrow trephyne and aspiration
were obtained being consistent with selective red cell aplasia
except for identification of giant pronormoblasts (
Figure
1). ELISA test for IgM
and IgG antibodies to Parvoirus B19 (PVB19) were positive.
Unspecific intravenous imunoglobulin therapy (1 g/Kg/ weight) was
administered and reticulocytes appeared at 6 days and increased
thereafter with parallel normalization of anemia to 14 gr/dl
hemoglobin at 2 months. No evidence of hemolytic anemia or
underlying immunosupression, including immnunoglobulin serum
levels and test for HIV, have been documented, althougth followup
is warranted. Transient erythroblastopenia and chronic pure red
cell aplasia are both asociated to PVB19 infection. Mostly these
tend to occur in patients with underlying stress erythropoyesis,
as hemolytic anemias, or inmunosupressión as a factor
favouring persistent infection respectively.1 Despite
tropism for erythroid cells as target for replication and direct
cytopathic effect, PVB19 has been asociated to other hematological
manifestations as inmune hemolytic anemia, megacariocytic
thrombocytopenia, bone marrow aplasia and the hemophagocytic
syndrome.2,3 Either DNA analysis or inmunological
response to the virus ( IgM antibodies for recent exposure) are
used for diagnosis of PVB19 infection, however the finding of
scattered giant pronormoblast in bone marrow smears or trephyne is
considered highly specific and the morphological hallmark of PVB19
infection.4
