Transient aplastic crisis in patients with sickle cell disease. B19 parvovirus studies during a 7-year period
S. P. Rao, S. T. Miller and B. J. Cohen
Department of Pediatrics, State University of New York Children's Medical Center of Brooklyn 11203.
OBJECTIVE--To determine (1) the proportion of cases of transient aplastic
crisis (TAC) in patients with sickle cell disease due to B19 parvovirus
infection in several years, (2) longitudinally, the immune response to B19
parvovirus infection, and (3) whether patients with sickle cell disease
experience recurrent or chronic B19 parvovirus infection.
DESIGN--Prospective evaluation of patients with sickle cell disease and TAC
to find evidence of B19 parvovirus infection and, if present, to document
the pattern of serologic response with time. SETTING--Large urban teaching
hospital. PATIENTS--Patients younger than 18 years with sickle cell disease
who were admitted to the hospital with a diagnosis of TAC or who developed
TAC while in the hospital for other reasons. Follow-up serologic studies of
B19 parvovirus infection were done in eight patients. MEASUREMENTS/MAIN
RESULTS--Serum was tested for B19 parvovirus DNA/viral particles and
specific anti-B19 parvovirus IgM and IgG antibodies. B19 parvovirus
DNA/viral particles were detected in 11 (21%) of 53 patients with TAC.
Specific anti-B19 parvovirus IgM antibodies were detected in 34 (64%) of
the 53 patients. Overall, 36 (68%) of 53 patients with TAC had evidence of
acute B19 parvovirus infection as shown by the detection of B19 DNA
parvovirus and/or specific anti-B19 parvovirus IgM antibodies in
acute-phase serum. Follow-up serologic studies in eight patients with acute
infection revealed disappearance of B19 parvovirus DNA/viral particles and
anti-B19 parvovirus IgM antibodies and persistence of anti-B19 parvovirus
IgG antibodies for up to 3 1/2 years after the diagnosis of acute B19
parvovirus infection. No patient had evidence of recurrent or chronic B19
parvovirus infection. CONCLUSIONS--Approximately 70% of cases of TAC in
patients with sickle cell disease identified in a 7-year period were caused
by acute B19 parvovirus infection. Once detected, anti-B19 parvovirus IgG
antibodies remain detectable for several years. There was no evidence of
chronic or recurrent B19 parvovirus infection in patients with sickle cell
disease.
