Pure red cell aplasia due to parvovirus B19 infection after liver transplantation: A case report and review of the literature

Table 1 Main characteristics of 8 liver transplant recipients with PRCA due to PVB19 infection

Case	1	2	3	4	5	6	7	8
Age when anemia (yr)	1.8	4.7	1.4	1.4	26	43	41	38
Sex	F	F	M	M	F	M	M	M
Immunosuppression	FK	CsA	FK	FK	AZA + FK + Co	AZA + FK	CsA + AZA + Co	FK + MMF + Co
Anemia onset (month after LTx)	2	34	6	8	30	1	11 d	3 wk
Lowest Hb (g/L)	46	73	69	70	33	54	75	21
Reticulocyte count	0	0.40%	0	0.80%	0	0	ND	0.40%
Other manifestation	Erythema infectiosum	None	Fever, stridor, leucopenia	None	Arthralgia	None	Fever	None
Bone marrow biopsy	ND	ND	GP	ND	GP	GP	ND	GP
PVB19 IgM	P	P	P	P	P	P	N	ND
PVB19 IgG	P	P	N	P	P	N	P	ND
PVB19 DNA	ND	ND	ND	ND	P	P	P	P
Treatment	IVIG: 1 g/d × 3 d	IVIG: 0.4 g/kg per day × 10 d, 12 courses	IVIG: 0.4 g/kg per day × 5 d	IVIG: 0.4 g/kg per day × 5 d	IVIG: 0.4 g/kg per day × 10 d, plasmapheresis	IVIG	ND	IVIG: 0.4 g/kg per day × 5 d × 2 courses
Outcome	Hb normalized 4 wk after IVIG	Hb normalized 2 wk after IVIG	Hb normalized 4 wk after IVIG	Hb normalized 2 wk after IVIG	Hb normalized and virus DNA negative 16 wk after plasmapheresis	Hb normalized and virus DNA negative 3 wk after IVIG	ND	Hb normalized 12 wk after IVIG with long-term low-level viral load and virus DNA negative 5 mo after Hb normalization
Reference	[16]	[16]	[16]	[16]	[17]	[18]	[19]	This case

PRCA: pure red cell aplasia; PVB19: parvovirus B19; F: female; M: male; FK: FK506; CsA: cyclosporine A; AZA: azathioprine; MMF: mycophenolate mofetil; Co: corticoteroids; LTx: liver transplantation; Hb: hemoglobin; ND: not determined; GP: giant pronomorblasts; P: positive; N: negative; IVIG: intravenous immunoglobulin.