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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

Hemoglobin correction and dexamethasone treatment. Effects of pulse high dose dexamethasone treatment on hemoglobin level. The green triangles stand for day one of dexamethasone 40mg/day for four constitutive days. The red squares stand for erythrocytes transfusion.
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Fig7: Hemoglobin correction and dexamethasone treatment. Effects of pulse high dose dexamethasone treatment on hemoglobin level. The green triangles stand for day one of dexamethasone 40mg/day for four constitutive days. The red squares stand for erythrocytes transfusion.

Mentions: TAC caused by B19 virus infection in a pregnant woman with cold antibody autoimmune hemolytic anemia (AIHA) was diagnosed. She received intravenous immunoglobulin (IVIG) injection (CSL Limited, Parkville, Australia), 0.4gm/Kg/day for five days, for eradication of viremia and prophylaxis of occurrence of hydrops fetalis. Although her peripheral blood reticulocyte percentage increased dramatically after IVIG treatment (Figure 6), her hemolytic anemia did not improve much. In order to control her autoimmune hemolysis, intravenous high dose dexamethasone (Astar Chem. & Pharm., Hsinchu, Taiwan), 40mg/day for four days, was prescribed. This treatment was repeated every two weeks for four cycles and then shifted to a monthly oral schedule. She was discharged in a stable condition after the fourth intravenous treatment and received careful follow-up study in our outpatient clinic. No more erythrocytes were transfused after the fifth course of high dose dexamethasone (Figure 7) in spite of persistent mild anemia. During her hospitalization and subsequent outpatient clinic visits, obstetric ultrasound did not reveal any evidence of fetal anemia and hydrops fetalis. Four months later, a normal looking healthy baby boy (Apgar score 8 at one minute and 9 at five minutes, body weight 3240gm) was naturally delivered with vacuum extraction aid. After delivery of the baby, her AIHA quickly resolved.Figure 6


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)

Hemoglobin correction and dexamethasone treatment. Effects of pulse high dose dexamethasone treatment on hemoglobin level. The green triangles stand for day one of dexamethasone 40mg/day for four constitutive days. The red squares stand for erythrocytes transfusion.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig7: Hemoglobin correction and dexamethasone treatment. Effects of pulse high dose dexamethasone treatment on hemoglobin level. The green triangles stand for day one of dexamethasone 40mg/day for four constitutive days. The red squares stand for erythrocytes transfusion.
Mentions: TAC caused by B19 virus infection in a pregnant woman with cold antibody autoimmune hemolytic anemia (AIHA) was diagnosed. She received intravenous immunoglobulin (IVIG) injection (CSL Limited, Parkville, Australia), 0.4gm/Kg/day for five days, for eradication of viremia and prophylaxis of occurrence of hydrops fetalis. Although her peripheral blood reticulocyte percentage increased dramatically after IVIG treatment (Figure 6), her hemolytic anemia did not improve much. In order to control her autoimmune hemolysis, intravenous high dose dexamethasone (Astar Chem. & Pharm., Hsinchu, Taiwan), 40mg/day for four days, was prescribed. This treatment was repeated every two weeks for four cycles and then shifted to a monthly oral schedule. She was discharged in a stable condition after the fourth intravenous treatment and received careful follow-up study in our outpatient clinic. No more erythrocytes were transfused after the fifth course of high dose dexamethasone (Figure 7) in spite of persistent mild anemia. During her hospitalization and subsequent outpatient clinic visits, obstetric ultrasound did not reveal any evidence of fetal anemia and hydrops fetalis. Four months later, a normal looking healthy baby boy (Apgar score 8 at one minute and 9 at five minutes, body weight 3240gm) was naturally delivered with vacuum extraction aid. After delivery of the baby, her AIHA quickly resolved.Figure 6

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