Acquired Pure Red Cell Aplasia caused by Parvovirus B19 Infection following a Renal Transplant

Abstract

We report a young Omani male who developed severe and persistent anaemia after a kidney transplantation while being on immunosuppression therapy, standard practice to prevent rejection of the transplanted kidney. His bone marrow aspirate showed the classic morphological changes of pure red cell aplasia (PRCA), induced by parvovirus B19 infection which is the presence of giant proerythroblasts with viral inclusions. The virus was also demonstrated by polymerase chain reaction in the blood along with IgM antibodies to parvovirus B19. He responded dramatically to high dose immunoglobulin with a normalisation of his haemoglobin level in two weeks and remained normal until seven months later. Parvovirus B19 induced PRCA can be cured. This aetiology must be kept in mind especially when a chronic anaemia, refractory to treatment, is accompanied by a reticulocytopenia. The latter reflects the lysis of the proerythroblasts, preventing maturation of the erythroid cells causing anaemia. Early recognition and prompt treatment spares the patient unnecessary exposure to blood transfusions, erythropoietin and renal disease caused by the virus. PRCA secondary to parvovirus B19 infection following kidney transplantation is reported in the literature, but not in the Omani population. To the best of our knowledge, this is the first such report in Oman.

Keywords: Case report; Immunosuppuression; Oman; Red cell aplasia, pure; human parvovirus B19; kidney transplantation.

Figure 1:

Bone marrow smear showing two giant proeythroblasts. One intact with intranuclear eosinophilic inclusion body like nucleoli. Arrow points to ‘dog ear’ cytoplasmic projections. Adjacent is a denuded nucleus of a giant proerythroblast. (× 1000).

Figure 2:

Trephine biopsy. Arrow points to three giant proerythroblasts with a megakaryocyte at the left hand end of the row (×1000).

Figure 3:

Trephine biopsy - glycophorin stain giant proerythroblasts staining positive (×1000).