Mujtaba Hasnain
Saint Barnabas Medical Center, USA
Title: Refractory anemia caused by parvovirus B19 infection in kidney transplant recipient
Biography
Biography: Mujtaba Hasnain
Abstract
Anemia is a common problem in patients (pt) after kidney transplantation (KT). The causes of posttransplant anemia include ineffective erythropoietin, medication side effects, nutritional deficiencies, and, less commonly, infections. Human Parvovirus B19 (PV B19) is infrequently considered as a cause of anemia. It should always be considered as an etiology of resistant anemia in KT patients.Our pt is a 43 year old male with end stage renal disease due to Alport syndrome who received a living unrelated renal transplant. He was given simulect induction and finally his immunosuppression (IS) consisted of prednisone, tacrolimus and mycophenolic acid (MFA). He presented with fever and fatigue 6 weeks after the transplant. His hematocrit (hct) was found to be 18.7%. After 2 units of pack red blood cells (PRBC) transfusion, his hct improved. His iron stores, stool guaiac, vit B12 and serum folic acid levels were unrevealing. There was no evidence of hemolysis. His serum PV B19 PCR result was >100,000,000 copies/ml. Initially MFA was held but ultimately he was given intravenous immunoglobulin (IVIG) at 1g/kg due to refractory anemia and persistently elevated PV B19 level. He presented again within 1 week of receiving three doses of IVIG with exertional dyspnea and fatigue. He was transfused PRBCs again due to presence of severe anemia with hct of 16.1 %. Another dose of IVIG was given as his repeat serum PV B19 result was >2.6 million copies/ml. His subsequent hct levels has been stable with PV B19 levels now steadily decreasing.PV B19 is a single stranded DNA virus belonging to the family Parviviridea. Though not common, it can cause red cell aplasia in immunocompromised patients. When other causes of anemia have been eliminated, investigation into an acute PV B19 infection should be a part of the work up. Treatment of acute PV B19 associated red cell aplasia can be either conservative by decreasing IS or more aggressive with the use of IVIG.