Tsuda H, Shirono K, Shimizu K, Shimomura T
Division of Clinical Hematology/Immunology, Kumamoto City Hospital.
Rinsho Ketsueki. 1995 Jul;36(7):672-6.
A 30-year-old postpartum woman was admitted to our hospital because of progressive anemia, malaise, night sweating, headache and low grade fever which began 9 days after delivery (day 0). She had normocytic hypochromic anemia accompanied with marked decrease in reticulocytes. In addition, a temporary decrease in platelets and white blood cells especially neutrophils were observed. Bone marrow smears showed an apparent decrease in erythroid cells and the presence of giant proerythroblasts (1.2%) as well as hemophagocytes (1.2%). IgM and IgG antibody against human parvovirus B19 (HPV) was detected on day 22 of the disease although negative results were obtained on day 3. The presence of the virus in the blood on admission was confirmed by dot-blot analysis. Thus, this case was diagnosed as acute pure red cell aplasia and hemophagocytic syndrome caused by HPV infection. This patient had been given iron for iron deficiency anemia before delivery and the iron deficiency was still present after the episode of the present disease although the iron metabolism data was perturbed during the disease. These findings suggest that HPV could cause acute pure red cell aplasia not only in patients with hemolytic anemia but also in patients with iron deficiency anemia or after acute bleeding. Furthermore it is suggested that pancytopenia often observed on HPV infection could be at least partly caused by hemophagocytic syndrome.
一名30岁的产后女性因产后9天（第0天）开始出现进行性贫血、乏力、盗汗、头痛和低热而入住我院。她患有正细胞低色素性贫血，同时网织红细胞显著减少。此外，还观察到血小板和白细胞尤其是中性粒细胞暂时减少。骨髓涂片显示红系细胞明显减少，存在巨大早幼红细胞（1.2%）以及噬血细胞（1.2%）。在疾病第22天检测到抗人细小病毒B19（HPV）的IgM和IgG抗体，而在第3天结果为阴性。入院时通过斑点印迹分析证实血液中存在该病毒。因此，该病例被诊断为HPV感染引起的急性纯红细胞再生障碍性贫血和噬血细胞综合征。该患者在分娩前曾因缺铁性贫血接受铁剂治疗，尽管在疾病发作期间铁代谢数据受到干扰，但在本次疾病发作后缺铁情况仍然存在。这些发现表明，HPV不仅可在溶血性贫血患者中引起急性纯红细胞再生障碍性贫血，也可在缺铁性贫血患者或急性出血后引起。此外，提示HPV感染时经常观察到的全血细胞减少至少部分是由噬血细胞综合征引起的。
