Kurukulasuriya Arundathi, Hamed Amal A, Al-Muslahi Muhanna, Ibrahim Asaid
Department of Hematology & Blood Transfusion, Royal Hospital, Muscat, Oman;
Sultan Qaboos Univ Med J. 2011 May;11(2):280-3. Epub 2011 May 15.
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.
我们报告了一名年轻的阿曼男性，他在肾移植后接受免疫抑制治疗（预防移植肾排斥的标准做法）期间出现了严重且持续的贫血。他的骨髓穿刺显示出由细小病毒B19感染引起的纯红细胞再生障碍（PRCA）的典型形态学变化，即存在带有病毒包涵体的巨大早幼红细胞。通过聚合酶链反应在血液中检测到了该病毒，同时还检测到了针对细小病毒B19的IgM抗体。他对大剂量免疫球蛋白反应显著，两周内血红蛋白水平恢复正常，直到七个月后一直保持正常。细小病毒B19诱导的PRCA是可以治愈的。当慢性贫血对治疗无效且伴有网织红细胞减少时，必须牢记这种病因。后者反映了早幼红细胞的溶解，阻止了导致贫血的红系细胞成熟。早期识别和及时治疗可使患者避免不必要的输血、促红细胞生成素暴露以及该病毒引起的肾脏疾病。文献中报道了肾移植后继发于细小病毒B19感染的PRCA，但阿曼人群中未见报道。据我们所知，这是阿曼的首例此类报告。
