Parvovirus B19 infection presenting with severe erythroid aplastic crisis during pregnancy in a woman with autoimmune hemolytic anemia and alpha-thalassemia trait: a case report

Chen, Chi-Ching; Chen, Chin-Shan; Wang, Weiyao; Ma, Jui-Shan; Shu, Hwei-Fan; Fan, Frank S.

doi:10.1186/s13256-015-0542-7

Cited by 9 publications

(5 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19-infected erythroblast cells with intranuclear inclusions have been observed in placenta and fetal tissue by many authors with histology and electron microscopy methods [1,3,5]. In our research the histopathological assessment of placenta in case of parvovirus infection is characterized by pronounced placentitis with edema due to the cytolytic action of viruses in the core of endothelial cells of the blood capillaries, as well as in the cytoplasm, myelin-like structures, which contributes to the enhancement of lipid peroxide oxidation.…”

Section: Discussionmentioning

confidence: 55%

“…Maternal alpha-fetoprotein is correlated with both Doppler blood flow velocity parameters in the middle cerebral artery and fetal hemoglobin. Elevations of this marker may appear earlier than Doppler abnormalities in cases of fetal anemia associated with hydrops [3].…”

Section: Introductionmentioning

confidence: 93%

“…However, its role in anemia and erythropoiesis is less recognized. Levels of this biochemical marker can be elevated in women infected by parvovirus B19 and probably come of from damage fetal liver cells or infected placental cells [3], but there is still no clear data on this fact, which is particularly relevant. Maternal alpha-fetoprotein is correlated with both Doppler blood flow velocity parameters in the middle cerebral artery and fetal hemoglobin.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Placental Cytopathic Damage Factor Due to Parvovirus B19 – As a Hallmark of Intrauterine Symptomathy of Infected Fetus

Bondarenko

Aksonova

2018

Technology transfer: innovative solutions in medicine

View full text Add to dashboard Cite

Aim of the work. The focus of this study was to analyze the frequency of fetal intrauterine symptomatic realization as a result of B19 parvovirus infection of pregnant women during I and II gestation periods, with the combination of determination the levels of alpha-fetoprotein in maternal serum blood and histopathological investigation of placenta in cases of negative effects for infected fetuses. Materials and methods. A total of 478 pregnant women were at risk of infection and screened for parvovirus B19. The study was based on serological, morphological and virological testing of fetuses from mothers with confirmed parvovirus B19 infection. Infection of pregnant women was detected by serological diagnosis of specific antibodies IgM and IgG to parvovirus B19. Intrauterine fetal infection was confirmed by polymerase chain reaction method. Levels of alpha-fetoprotein in meternal venous blood were detected using an immunochemical test method. An antenatal diagnosis of hydrops fetalis was confirmed by ultrasound scanning. Placenta from the 8 infected fetuses was studied histologically with hematoxylin and eosin staining using electron microscope during gestational periods of 12-22 weeks. Statistical analysis of the obtained data was carried out using nonparametric statistics with the definition of Fisher's criterion. Results and discussion. The average gestational period of symptomatic manifestations of intrauterine fetal infection was 19.9±0.5 weeks of gestation. It was established that in 33 of cases were confirmed the intrauterine infection due to parvovirus B19 by using the morphological placenta tissue analysis. The research found that the levels of maternal serum alpha-fetoprotein was significantly higher (in 2.17 times) in group of fetuses who suffered from fetal hydrops and in cases of intrauterine fetal death before detecting the general echographic sings of fetal failure (p˂0.05). It will be very important to compare this indicator with the Doppler ultrasound measurements of the human fetal middle cerebral artery peak systolic velocity (MCA PSV) and blood flow parameters in the fetal ductus venosus and to predict the possibility of poor perinatal outcomes. It was identified a cytopathic effect in placental cells viral origin and detected in cells of the cytotrophoblast, syncytiotrophoblast, endothelial cells, and blood cells. Conclusions. Parvovirus B19 fractions were visualized in 100 % of cases of miscarriages with fetal hydrops and placental edema during 12-22 weeks of gestation, while acute maternal parvovirus infection (with the detection of IgM against to parvovirus B19) was diagnosed by immunoassay only in 62.5 % of cases. Detection of B19 particles in placental tissue from fetuses with non-immune origin hydrops is an auxiliary method in the diagnosis of vertical transmission of parvovirus during pregnancy. It is more preferable to estimate the levels of alpha-fetoprotein in maternal serum blood in case of parvovirus B19 affected pregnancies as raising rates of this marker may be an early prediction hallmark for adverse fetal outcome.

show abstract

Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Placental Cytopathic Damage Factor Due to Parvovirus B19 – As a Hallmark of Intrauterine Symptomathy of Infected Fetus

Bondarenko

Aksonova

2018

Technology transfer: innovative solutions in medicine

View full text Add to dashboard Cite

show abstract

“…A case of maternal severe transient aplastic crisis, on the background of shortened lifespan of erythrocytes, was recently reported due to B19 infection during pregnancy [ 21 ]. In addition, Rajput et al reported a case of severe aplastic anemia in a previously healthy adult female because of acute parvovirus B19 infection [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Preservative Monitoring of a Greek Woman with Hydrops Fetalis due to Parvovirus B19 Infection

Fasoulakis

Antsaklis

Kontomanolis

2017

Case Reports in Obstetrics and Gynecology

View full text Add to dashboard Cite

Primate erythroparvovirus 1 (parvovirus B19) is a member of the Erythrovirus genus of the Parvoviridae family and it is one of the few members of the family known to be pathogenic in human. B19 infection is common and widespread with the virus being associated with numerous rheumatologic and haematologic manifestations. More specifically, maternal infection with parvovirus B19 during pregnancy can cause severe anemia which may lead to nonimmune hydrops or fetal demise, as a result of fetal erythroid progenitor cells infection with shortened half-life of erythrocytes. We present a rare case reported in the Greek population, of subclinical transient reticulocytopenia due to B19 parvovirus infection, in an asymptomatic pregnant woman, without medical history of hemoglobinopathy, and with the presence of hydrops fetalis during the third trimester of her pregnancy.

show abstract

“…Гістологія ембріонів, інфікованих парвовірусом, показала значне зменшення еритропоетичних островців у паренхімі печінки. Вчені зробили висновок, що вплив ПВ19 може бути небезпечним для гемопоетичної системи плода, оскільки кількість незрілих попередників еритроцитів та інтенсивність гемопоезу плода в 3-5 разів перевищують дорослу форму гемопоезу у плода з тяжкою фетальною анемією (ФА) [14,21,31]. Цитоморфологічні дослідження плаценти та тканини серця інфікованих загиблих плодів доводять, що ПВ19 має цитолітичний вплив на ендотеліальні клітини плаценти, викликає апоптоз клітин трофобласту, вражає печінку плода, а також є чинником фетального міокардиту [9,15].Внаслідок ураження ланок кровоутворення у плода розвивається стійка лейкопенія за рахунок різкого зменшення нейтрофілів та тромбоцитопенія [16].…”

Section: резюмеunclassified

The Risk of Perinatal Losses Due to Parvovirus Infection During Pregnancy and Ways to Prevent Them

Bila,

Bondarenko,

Tyshkevich

et al. 2023

Neonatol. hìr. perinat. med.

View full text Add to dashboard Cite

The course of pregnancy in infected women in endemic and epidemic situations is associated with a high risk of perinatal losses. However, there is no specifi c etiotropic therapy for parvovirus infection. Insuffi cient records of clinical forms of the infection, possible subclinical or asymptomatic manifestation during pregnancy, and lack of clear indications for examination, require the implementation of eff ective methods aimed at preventing the negative consequences of parvovirus infection during pregnancy. Undoubtedly, in the time of modern medical achievements, gaining new knowledge about the eff ects of parvovirus infection allows early diagnosis of PV19 in pregnant women. The increasing availability of a procedure such as intrauterine red blood cell transfusion has signifi cantly improved the survival prognosis of fetuses with PV19-induced non-immune hydrops, but there is a lot of imprecise data, as this treatment could not completely prevent fetal death. This made it necessary to defi ne and develop effi ciency criteria for this method of treatment. Taking into account the fact that the frequency of perinatal fetal loss due to parvovirus infection is steadily increasing and the problems of the clinical course of pregnancy as well as the prediction of the consequences of parvovirus infection for the fetus at diff erent stagesof pregnancy have not been resolved yet, the algorithm of pregnancy management in case of possible infection with PV19 should be studied nowadays. All these arguments were the reason for conducting this scientifi c research.The purpose of this work is to reduce the frequency of perinatal losses due to intrauterine infection by developing an algorithm for the management of pregnancy with parvovirus infection. Research materials and methods. The study was conducted within the framework of the research topic of the Department of Obstetrics and Gynecology No. 1 of the Bogomolets National Medical University “Restoration and preservation of reproductive health and quality of life of women with obstetric and gynecological pathology in modern conditions” (state registration number 0113U007336). To achieve the purpose of this work, a screening examination of 1090 pregnant women was performed to detect maternal vulnerability to parvovirus infection. The survey included women who had symptoms of a viral disease during pregnancy or were at a high risk of contact with infected people (worked in healthcare, kindergarten, or school, or had children under the age of 14 at home). At the second stage of the study, a core group of 129 patients with a positive test result for parvovirus B19 was formed. The further course of pregnancy, the delivery, method, and perinatal consequences in these women were analyzed. By decision of Bioethics Commission No.1 on 30.02.2020 the research materials meet the requirements accepted by the international community and the current regulatory and legal acts of Ukraine, and the requirements of the Code of Conduct for doctors of Ukraine.Research results. Based on the study of pregnant women from the risk group of infection, it was established that the frequency of detection of parvovirus infection in the structure of obstetric pathology is 11.8%. The rate of perinatal mortality is particularly high in cases of non-immune dropsy of the fetus due to infection with parvovirus B19, which is 108.6‰. An algorithm for the management of pregnant women was developed, which made it possible to reduce the frequency of perinatal losses with parvovirus infection. This algorithm was implemented thanks to early diagnosis of this pathology among pregnant women with a high risk of the disease, serial determination of alpha- fetoprotein indicators in maternal blood, weekly ultrasound monitoring of the condition of the fetus with Doppler blood fl ow in the middle cerebral artery and ductus venosus of the fetus for 10 weeks. When severe fetal anemia manifested in a fetus with non-immune dropsy, intrauterine blood transfusion sessions were performed, optimally at 23-25 weeks of pregnancy. The eff ectiveness of carrying out blood transfusion for a fetus with non-immune dropsy due to PV19 will be successful if the following criteria are followed, namely: the viral load in the umbilical cord blood does not exceed 4×10×5 MO/ml, max peak systolic blood fl ow velocity in a middle cerebral artery – 1.95±0.4 MOM, gestational age – 24±1.0 (23-25) week, normal indicators of blood fl ow in the venous duct of the fetus, no USG signs of myocarditis. Intrauterine blood transfusion of a fetus with non-immune dropsy due to parvovirus infectionin the II trimester of pregnancy was successful in 72.7% (р=0.005). In the case of detection of both compensated and decompensated umbilical cord artery disorders in the period of 27-32 weeks in the presence of blood fl ow disorders in the ductus venosus, premature delivery by cesarean section was performed.Conclusions. Pregnancy management according to the developed algorithm, in comparison with routine pregnancy management, reduces the relative risk of antenatal fetal death by 21% (р=0.590), the risk of early neonatal mortality by 84% (р=0.003), the risk of perinatal mortality by 77% (р= 0.0004). The obtained data proves the prevailing effi ciency of the proposed algorithm.

show abstract

Parvovirus B19 infection presenting with severe erythroid aplastic crisis during pregnancy in a woman with autoimmune hemolytic anemia and alpha-thalassemia trait: a case report

Cited by 9 publications

References 14 publications

Placental Cytopathic Damage Factor Due to Parvovirus B19 – As a Hallmark of Intrauterine Symptomathy of Infected Fetus

Placental Cytopathic Damage Factor Due to Parvovirus B19 – As a Hallmark of Intrauterine Symptomathy of Infected Fetus

Preservative Monitoring of a Greek Woman with Hydrops Fetalis due to Parvovirus B19 Infection

The Risk of Perinatal Losses Due to Parvovirus Infection During Pregnancy and Ways to Prevent Them

Contact Info

Product

Resources

About