AM Report 1/24/17: Pure Red Cell Aplasia (PRCA) due to Parvovirus B19

Etiology of Acquired PRCA (can also be congenital

IDIOPATHIC (most common)
-Drugs (Phenytoin, Bactrim, Zidovudine, Mycophenolate, INH etc.)
-Infections (Parvovirus B19, HIV, Viral Hepatitis)
Auto-Immune (SLE, RA, auto-immune hemolytic anemia, ABO incompatible HCT, Epo treatment)
Lymphoid malignancies (CLL, HL, NHL, Myeloma)
Myeloid malignancies (CML, myelodysplastic syndrome, other cancers)
-Thymoma
Pregnancy

Making the Diagnosis of PRCA (all 4 criteria must be met)

  • Normocytic Normochromic anemia
  • Very low or zero reticulocyte count with ARC <10,000/microL
  • NORMAL WBC count and platelet count

 

Bone Marrow Biopsy: Normocellular bone marrow with normal myeloid, lymphoid, and megakaryocytopoiesis but minimal erythroid precursors

LOW reticulocyte count=reduced bone marrow response

  • AOCD, mild/moderate IDA, renal failure, PRCA

HIGH reticulocyte count=preserved bone marrow response

  • Hemolysis, bleeding, Sickle cell, RBC membrane disorders

General treatment of PRCA 

-RBC transfusion for symptomatic anemia
-STOP any possible offending drugs (see above)
-Search and treat any associated conditions
Immunosuppression (Glucocorticoids/Cyclosporine/Cyclophosphamide etc)

Specific Treatment for Parvovirus B19 related PRCA

Immunocompetent (usually spontaneous resolution within 2-3 weeks)
Immunocompromised (Usually will not spontaneously resolve and can develop chronic infection) Treatment of choice is IVIG

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