Parvovirus B19 as a cause of acquired chronic pure red cell aplasia |
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Authors: | N. Frickhofen,Z. J. Chen,N. S. Young,&dagger B. J. Cohen,&Dagger H. Heimpel, J. L. Abkowitz,§ |
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Affiliation: | Department of Medicine III, University of Ulm, Germany;Clinical Hematology Branch, NHLBI, Bethesda, Maryland, U.S.A.;Central Public Health Laboratory, London, U.K.;Department of Medicine, University of Washington, Seattle, Washington, U.S.A. |
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Abstract: | Parvovirus B19 infection causes chronic anaemia in immunodeficient individuals by selective suppression of erythropoiesis. The bone marrow morphology is character-istic of pure red cell aplasia (PRCA). To determine the frequency of B19-induced PRCA we retrospectively analysed a series of 57 PRCA patients. B19 DNA was present in serum of eight patients (14%) and could be extracted from bone marrow aspirate slides from five of these patients. Recent exposure to the virus was confirmed by the presence of anti-B19 IgM in sera from four and by the finding of giant pronormoblasts in marrow aspirates from five of the B19 DNA-positive patients. The sensitivities of anti-B19 IgM and of giant pronormoblasts were only 50% and 63%, respectively; specificites were 90% and 92%. Unexpectedly, PRCA in two B19 DNA-positive patients remitted after antilymphocyte globulin or cyclosporin A therapy, suggesting that the clinical course of B19-induced PRCA may be indistinguishable from other forms of PRCA. As therapy with immunoglobulin is uniformly effective for treatment of B19-associated anaemia, our data suggest that all patients with acquired PRCA should be evaluated for evidence of B19 infection. B19 DNA analysis is the most reliable method to demonstrate infection. |
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Keywords: | parvovirus anaemia pure red cell aplasia infection DNA PCR |
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