PAROVIRUS B19-INDUCED RED-CELL APLASIA IN SOLID-ORGAN TRANSPLANT RECIPIENTS - 2 CASE-REPORTS AND REVIEW OF THE LITERATURE

Two solid-organ transplant recipients (one heart and one lung) develop ed severe anemia with reticulocytopenia. Both were heavily immunosuppr essed. Bone marrow aspiration revealed almost complete absence of eryt hroid precursors. A few giant megaloblastic proerythroblasts with cyto plasmic vacuolisation and intranuclear inclusions were seen. Human par vovirus B19 (B19V)-DNA genome was found by nested-PCR assays in blood and bone marrow samples in both cases. Twelve similar cases are descri bed in the literature. When looked for, B19V DNA was positive either i n serum or bone marrow or both. Twelve of the fourteen patients were s uccessfully treated by high dose i.v. immunoglobulin (IVIG). One patie nt recovered spontaneously and another after treatment with recombinan t human erythropoietin (rHu-EPO) only. Transplant patients should be c onsidered at risk for severe erythroblastopenic anemia due to B19V inf ection. Diagnosis is based on bone marrow examination and detection of B19V DNA by PCR in serum and/or marrow. IVIG is an effective and safe treatment. The role of erythropoietin in this indication needs furthe r study.