Ma Xiantao, Hou Ningxin, Li Chenhe, Feng Yi, Zhang Xiaoxue, Li Shiliang, Cheng Cai
Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China.
Department of Cardiovascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, China.
J Int Med Res. 2025 Sep;53(9):3000605251377626. doi: 10.1177/03000605251377626. Epub 2025 Sep 25.
Human parvovirus B19 infection in immunocompetent adults predominantly manifests as arthropathy or erythema infectiosum, with transient aplastic crisis being a rare hematological complication. We report a diagnostically challenging case of a man in his late 40s who developed recurrent severe aplastic anemia following mechanical valve replacement. Notably, the patient presented with progressive pancytopenia despite optimal anticoagulation and normally functioning prosthetic valves on serial echocardiograms. Critical diagnostic differentiation was achieved through comprehensive laboratory evaluation; elevated lactate dehydrogenase (232.00 U/L) and undetectable haptoglobin levels initially suggested mechanical hemolysis. However, suppressed reticulocyte production index (0.002) and the presence of human parvovirus B19 (DNA) confirmed virus-mediated marrow suppression. The absence of schistocytes on peripheral smear and stable hemoglobinuria levels further excluded prosthetic valve-related hemolysis. To the best of our knowledge, this study represents the first documented case of human parvovirus B19-induced aplastic anemia in a postcardiotomy patient with confirmed valve competence, highlighting three key clinical imperatives: 1. Human parvovirus B19 should be included in the differential diagnosis of postoperative pancytopenia regardless of immune status; 2. disproportionate reticulocytopenia with normal hemolysis markers may indicate viral marrow infiltration; and 3. serial echocardiographic surveillance cannot fully exclude subclinical hemolysis, necessitating multimodal laboratory correlation.
免疫功能正常的成年人感染人细小病毒B19主要表现为关节病或传染性红斑，短暂性再生障碍危象是一种罕见的血液学并发症。我们报告了一例诊断具有挑战性的病例，一名40多岁的男性在机械瓣膜置换术后出现反复严重再生障碍性贫血。值得注意的是，尽管进行了最佳抗凝治疗且系列超声心动图显示人工瓣膜功能正常，但该患者仍出现进行性全血细胞减少。通过全面的实验室评估实现了关键的诊断鉴别；乳酸脱氢酶升高（232.00 U/L）和触珠蛋白水平检测不到最初提示机械性溶血。然而，网织红细胞生成指数受抑制（0.002）以及人细小病毒B19（DNA）的存在证实了病毒介导的骨髓抑制。外周血涂片未见破碎红细胞且血红蛋白尿水平稳定进一步排除了人工瓣膜相关溶血。据我们所知，本研究是首例记录在案的心脏手术后人工瓣膜功能正常的患者发生人细小病毒B19诱导的再生障碍性贫血的病例，突出了三个关键的临床要点：1. 无论免疫状态如何，人细小病毒B19都应纳入术后全血细胞减少的鉴别诊断；2. 溶血标志物正常但网织红细胞减少不成比例可能提示病毒骨髓浸润；3. 系列超声心动图监测不能完全排除亚临床溶血，需要多模式实验室关联。
