Human parvovirus B19 infection presenting as persistent anemia in renal transplant recipients

Background. Immunosuppression cannot be achieved without immunosuppressive effects. Human Parvovirus infection is known to occur after organ transplan tation. We present our experience with Parvovirus infection in two cases. Methods and Results. Two kidney transplant recipients developed symptomatic anemia requiring blood transfusions. Common causes of anemia, such as gast rointestinal bleeding, iron/vitamin deficiencies, hemolysis, and drug toxic ities, were ruled out. A peripheral smear revealed low reticulocyte count. Bone marrow examination showed hypoplastic bone marrow with intranuclear in clusions suggestive of human Parvovirus. This was confirmed by immunohistoc hemical analysis. Treatment with i.v. immunoglobulin G resulted in a dramat ic sustained response. Transplant kidney function remained stable. Conclusion. Human Parvovirus infections should be considered in immunosuppr essed individuals with anemia with poor bone marrow response. Bone marrow e xamination can reveal viral inclusions and can be confirmed by immunohistoc hemical analysis. Intravenous immunoglobulin G results in resolution of ane mia.