Limits...
Parvovirus B19 infection presenting with severe erythroid aplastic crisis during pregnancy in a woman with autoimmune hemolytic anemia and alpha-thalassemia trait: a case report.

Chen CC, Chen CS, Wang WY, Ma JS, Shu HF, Fan FS - J Med Case Rep (2015)

Bottom Line: She received intravenous immunoglobulin treatment to reduce the risk of hydrops fetalis.Finally, her hemoglobin levels remained stable with no need of erythrocyte transfusion, and a healthy baby boy was naturally delivered.Close monitoring and adequate management can keep both mother and fetus safe.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Feng Yuan Hospital, No. 100, Ankang Road, Fengyuan District, Taichung City, 420, Taiwan. chan0118@msn.com.

ABSTRACT

Introduction: Parvovirus B19 virus commonly causes subclinical infection, but it can prove fatal to the fetus during pregnancy and cause severe anemia in an adult with hemolytic diseases. We present the case of a woman with autoimmune hemolytic anemia who was diagnosed with parvovirus B19-induced transient aplastic crisis during her second trimester of pregnancy and faced the high risk of both fetal and maternal complications related to this specific viral infection. To the best of our knowledge, the experience of successful intravenous immunoglobulin treatment for B19 virus infection during pregnancy, as in our case, is limited.

Case presentation: A 28-year-old and 20-week pregnant Chinese woman with genetically confirmed alpha-thalassemia trait was diagnosed with cold antibody autoimmune hemolytic anemia and suffered from transient aplastic crisis caused by B19 virus infection. She received intravenous immunoglobulin treatment to reduce the risk of hydrops fetalis. Her peripheral blood reticulocyte percentage recovered, but anemia persisted, so she underwent several courses of high dose intravenous dexamethasone for controlling her underlying hemolytic problem. Finally, her hemoglobin levels remained stable with no need of erythrocyte transfusion, and a healthy baby boy was naturally delivered.

Conclusions: Parvovirus B19 virus infection should be considered when a sudden exacerbation of anemia occurs in a patient with hemolytic disease, and the possible fetal complications caused by maternal B19 virus infection during pregnancy should not be ignored. Close monitoring and adequate management can keep both mother and fetus safe.

No MeSH data available.


Related in: MedlinePlus

Bone marrow core biopsy. Parvovirus B19 intranuclear viral inclusions (clear area) leading to chromatin marginalization to the vicinity of the nuclear membrane within two pronormoblasts indicated by the yellow arrows.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4363068&req=5

Fig4: Bone marrow core biopsy. Parvovirus B19 intranuclear viral inclusions (clear area) leading to chromatin marginalization to the vicinity of the nuclear membrane within two pronormoblasts indicated by the yellow arrows.

Mentions: Her initial bone marrow cytology showed myeloid hyperplasia and only very few erythroid precursors with erythroblasts in abnormal megaloblastic change (Figure 2), some of which presented with pseudopods or ‘dog ears’ (Figure 3), and almost no erythroid maturation beyond basophilic normoblasts. Her bone marrow biopsy revealed scattered erythroblasts displaying homogeneous ground glass intranuclear viral inclusions (Figure 4) and positive nuclear immunostaining of B19 virus (Figure 5). Polymerase chain reaction for B19 virus DNA was positive in specimens from her bone marrow, plasma and nasal cavity. Antibodies against Epstein-Barr virus (EBV) were not checked because she did not present with the symptoms and signs of infectious mononucleosis or lymphoproliferative disorders present in most reported cases of EBV-associated hemolytic anemia.Figure 2


Parvovirus B19 infection presenting with severe erythroid aplastic crisis during pregnancy in a woman with autoimmune hemolytic anemia and alpha-thalassemia trait: a case report.

Chen CC, Chen CS, Wang WY, Ma JS, Shu HF, Fan FS - J Med Case Rep (2015)

Bone marrow core biopsy. Parvovirus B19 intranuclear viral inclusions (clear area) leading to chromatin marginalization to the vicinity of the nuclear membrane within two pronormoblasts indicated by the yellow arrows.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4363068&req=5

Fig4: Bone marrow core biopsy. Parvovirus B19 intranuclear viral inclusions (clear area) leading to chromatin marginalization to the vicinity of the nuclear membrane within two pronormoblasts indicated by the yellow arrows.
Mentions: Her initial bone marrow cytology showed myeloid hyperplasia and only very few erythroid precursors with erythroblasts in abnormal megaloblastic change (Figure 2), some of which presented with pseudopods or ‘dog ears’ (Figure 3), and almost no erythroid maturation beyond basophilic normoblasts. Her bone marrow biopsy revealed scattered erythroblasts displaying homogeneous ground glass intranuclear viral inclusions (Figure 4) and positive nuclear immunostaining of B19 virus (Figure 5). Polymerase chain reaction for B19 virus DNA was positive in specimens from her bone marrow, plasma and nasal cavity. Antibodies against Epstein-Barr virus (EBV) were not checked because she did not present with the symptoms and signs of infectious mononucleosis or lymphoproliferative disorders present in most reported cases of EBV-associated hemolytic anemia.Figure 2

Bottom Line: She received intravenous immunoglobulin treatment to reduce the risk of hydrops fetalis.Finally, her hemoglobin levels remained stable with no need of erythrocyte transfusion, and a healthy baby boy was naturally delivered.Close monitoring and adequate management can keep both mother and fetus safe.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Feng Yuan Hospital, No. 100, Ankang Road, Fengyuan District, Taichung City, 420, Taiwan. chan0118@msn.com.

ABSTRACT

Introduction: Parvovirus B19 virus commonly causes subclinical infection, but it can prove fatal to the fetus during pregnancy and cause severe anemia in an adult with hemolytic diseases. We present the case of a woman with autoimmune hemolytic anemia who was diagnosed with parvovirus B19-induced transient aplastic crisis during her second trimester of pregnancy and faced the high risk of both fetal and maternal complications related to this specific viral infection. To the best of our knowledge, the experience of successful intravenous immunoglobulin treatment for B19 virus infection during pregnancy, as in our case, is limited.

Case presentation: A 28-year-old and 20-week pregnant Chinese woman with genetically confirmed alpha-thalassemia trait was diagnosed with cold antibody autoimmune hemolytic anemia and suffered from transient aplastic crisis caused by B19 virus infection. She received intravenous immunoglobulin treatment to reduce the risk of hydrops fetalis. Her peripheral blood reticulocyte percentage recovered, but anemia persisted, so she underwent several courses of high dose intravenous dexamethasone for controlling her underlying hemolytic problem. Finally, her hemoglobin levels remained stable with no need of erythrocyte transfusion, and a healthy baby boy was naturally delivered.

Conclusions: Parvovirus B19 virus infection should be considered when a sudden exacerbation of anemia occurs in a patient with hemolytic disease, and the possible fetal complications caused by maternal B19 virus infection during pregnancy should not be ignored. Close monitoring and adequate management can keep both mother and fetus safe.

No MeSH data available.


Related in: MedlinePlus