Educational Objective:
Consider parvovirus infection as an etiology of red cell dysplasia in an immunocompromised patient.
Key Point:
In immunocompromised patients, severe anemia secondary to bone marrow red cell dysplasia can be caused by parvovirus B19V.
Explanation:
Parvovirus B19V is known chiefly as the cause of fifth disease, or erythema infectiosum, characterized by a "slapped-cheek" appearance in children and also by arthralgias in adults. In most individuals, infection with parvovirus B19V causes a transient, asymptomatic reticulocytopenia.
Infection with parvovirus B19V is also associated with pure red cell aplasia, with characteristic giant proerythroblasts in the bone marrow, particularly in patients with long-term immunosuppression. In immunosuppressed patients, intravenous immunoglobulin can be used to treat red cell aplasia due to parvovirus infection.
EBV, CMV, and HAV infections can cause a very brief red cell aplasia often not clinically recognized.
References:
Frickhofen N, Chen ZJ, Young NS, Cohen BJ, Heimpel H, Abkowitz JL. Parvovirus B19 as a cause of acquired chronic pure red cell aplasia. Br J Haematol. 1994;87:818-824.
Rogo LD, Mokhtari-Azad T, Kabir MH, et al. Human parvovirus B19 a review. Acta Virol. 2014;58:199-213.