ResumoObjetivo: Relatar a ocorrência de pancitopenia transitória, decorrente de infecção pelo parvovírus B19, em um paciente portador de anemia hemolítica hereditária e comentar a importância do diagnóstico desta infecção.Métodos: Relato de caso clínico acompanhado pelos autores, diagnosticado sorologicamente e pelo método da reação em cadeia da polimerase (PCR), e revisão da literatura.Resultados: Menino de 12 anos, portador de esferocitose hereditária, apresentando quadro infeccioso inespecífico seguido de pancitopenia grave, transitória, com diagnóstico de infecção por parvovírus B19.Conclusões: O diagnóstico da infecção por parvovírus B19 é de particular importância em hematologia, principalmente quando estão presentes algumas condições mórbidas, entre elas as anemias hemolíticas hereditárias, sendo o método de PCR útil por permitir rapidez e boa sensibilidade no diagnóstico específico desta patolog i a .J. pediatr. (Rio J.). 2000; 76(4): 323-326: pancitopenia, crise aplástica, anemias hemolíticas, esferocitose hereditária, parvovírus B19. AbstractObjective: To describe the occurrence of transient pancytopenia induced by parvovirus B19 infection in a patient with hereditary hemolytic anemia and to discuss the importance of the diagnosis of this pathology.Methods: Case report of a child whose diagnosis was made by polymerase chain reaction (PCR) and serology, and review of the literature.Clinical report: A twelve year-old male patient with hereditary spherocytosis, presenting non-specific symptoms of an infectious syndrome followed by severe and transient pancytopenia, whose diagnosis was a parvovirus B19 infection.Conclusion: The diagnosis of parvovirus infection has a particular importance in hematology, especially on some morbid conditions, among them the hereditary hemolytic anemias. PCR is useful because of its rapidness and sensitivity on the specific diagnosis of this disease. J. pediatr. (Rio J.). 2000; 76(4): 323-326: pancytopenia, aplastic crisis, hemolytic anemias, hereditary spherocytosis, parvovirus B19

The leptomeningeal involvement of central nervous system is defined in the most centers by the presence of blast cells in the CSF or the presence of cranial-nerve palsies. Sometimes, cytology does not allow clear distinction between lymphoblasts and normal cells, and auxiliary methods to the precise identification of leukemic cells in cerebrospinal fluid is necessary. We analyzed CSF from 11 consecutive patients, in whom a differential diagnosis of leptomeningeal involvement was made, including 4 patients at diagnosis and 7 patients during the treatment by cytomorphological analysis and PCR and automatic sequencing. Six patients were considered with leptomeningeal involvement by conventional analysis: unequivocal cytomorphological involvement was considered in 5 patients, and in one it was assumed to be due to cranial-nerve palsy, with no blast cells detected in cerebrospinal fluid. In 2 it was considered suspicious and in 3 negative. PCR and sequencing analysis showed involvement in 6 patients; 5 of the 6 patients were considered to have leptomeningeal involvement based on clinical and cytomorphological criteria, and, in one of the patients, it was suspicious. Our data suggest that the use of PCR and sequencing can be useful in confirming CNS leukemia and eliminating other conditions when used together with the cytomorphological analysis.

PCR using CDR-3 and TCR delta primers can be used as an aid for B lineage ALL diagnosis and clonal evolution of theses disease.

PCR detection of clonality using consensus primers is a relatively simple technique that is able to identify patients with a high chance of recurrence, and shows a higher sensitivity and a better prognostic value than standard morphologic analysis and risk group classification, defining a new remission criterion. However, further multicentric prospective studies using this technique employing a larger number of cases are necessary to confirm these findings.

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