Severe Anemia From Parvovirus B19 Infection in Pediatric Renal Transplant Recipients: Two Case Reports

Pinto, Viola; Grandy, Jean; Zambrano, Pedro; Corta, B.; Salas, P; Salgado, Izabel Athayde da Silva Cruz; Santander, Jessica; Salgado, Carmen; Chadid, J.; Íñiguez, R.

doi:10.1016/j.transproceed.2008.03.127

Cited by 15 publications

(9 citation statements)

References 15 publications

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“…But administrating tacrolimus alone or in combination was significantly associated with developing EBV infection. Interestingly, administering polyvalent immunoglobulins, considered to be one of the possible treatments for B19V infection, did not appear to be a protective factor [Schwarz et al, 1992; Sturm et al, 1996; Bertoni et al, 1997; So et al, 2000; Egbuna et al, 2006; Waldman et al, 2007; Pinto et al, 2008].…”

Section: Discussionmentioning

confidence: 99%

“…The first description of the B19V in renal transplantation was in 1986 in a context of flu‐like symptoms [Neild et al, 1986]. Since that time, a large number of cases have been reported mainly associating the infection with the onset of normochromic, normocytic, and aregenerative anemia [Eid et al, 2006; Beckhoff et al, 2007; Pinto et al, 2008]. A wide range of clinical manifestations have also been described, such as hepatitis, encephalitis, or vascularitis but the link between the [Bilge et al, 2005] disease and the B19V infection remains sometimes difficult to assess [Yoto et al, 1996; Shan et al, 2003; Eid et al, 2006; Laurenz et al, 2006].…”

Section: Introductionmentioning

confidence: 99%

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Frequent occurrence of parvovirus B19 DNAemia in the first year after kidney transplantation

Porignaux¹,

Vuiblet

Barbe³

et al. 2013

Journal of Medical Virology

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Described for the first time in 1986, Parvovirus B19 (B19V) infection in kidney transplant recipients remains little-known and probably underestimated. The aims of this study were to establish B19V infection frequency during the first year after kidney transplant and to determine predisposing factors and manifestations of the infection in renal transplant recipients. Sixty consecutive adult patients, transplanted less than a year before, were included in this study. B19V and other opportunistic viral infections were detected retrospectively in plasma samples collected every 15 days during the first 3 months and every month from 3 months to 1 year following the kidney transplant. Demographic characteristics, immunosuppressive treatment and biological findings were recorded on each sampling date. Six patients (10%) presented B19V viremia, while eight CMV (13.3%), seven EBV (11.7%), five HHV-6 (8.3%), five BKV (8.3%), and two adenovirus (3.3%) infections were detected. The mean value of B19V viral load was 149 UI/ml. B19V infections were either reactivation or reinfection due to genotype two in five cases, while one case of primary infection with genotype 1 was observed. Neither risk factors nor biological consequences of B19V infection have been identified. These results rank B19V third among opportunistic viral infections occurring during the first year after a kidney transplant. With regard to this high incidence, and even if the risk factors and biological consequences of the infection should be assessed in larger studies, the question of systematic screening and follow-up of B19V infection in kidney transplant recipients is relevant.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Frequent occurrence of parvovirus B19 DNAemia in the first year after kidney transplantation

Porignaux¹,

Vuiblet

Barbe³

et al. 2013

Journal of Medical Virology

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“…Various viruses including parvovirus B19 (PVB19), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) in KTR can cause aplastic anemia [ 2 ]. Parvovirus has been reported to cause pure red cell aplasia in KTR [ 225 ]. Acute rejection can cause post-transplant anemia due to decreased erythropoietin production and disturb the binding and transport of iron and folate through systemic inflammatory response [ 226 ].…”

Section: Differential Diagnosis Of Drug-induced Cytopeniamentioning

confidence: 99%

Drug-Induced Hematological Cytopenia in Kidney Transplantation and the Challenges It Poses for Kidney Transplant Physicians

Khalil

Khan

et al. 2018

Journal of Transplantation

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Drug-induced hematological cytopenia is common in kidney transplantation. Various cytopenia including leucopenia (neutropenia), thrombocytopenia, and anemia can occur in kidney transplant recipients. Persistent severe leucopenia or neutropenia can lead to opportunistic infections of various etiologies. On the contrary, reducing or stopping immunosuppressive medications in these events can provoke a rejection. Transplant clinicians are often faced with the delicate dilemma of balancing cytopenia and rejection from adjustments of immunosuppressive regimen. Differentials of drug-induced cytopenia are wide. Identification of culprit medication and subsequent modification is also challenging. In this review, we will discuss individual drug implicated in causing cytopenia and correlate it with corresponding literature evidence.

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“…In addition, immunosuppressant drugs induce increased susceptibility to virus such as parvovirus B19 (PVB19), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) in renal transplant recipients, which cause aplastic anemia (Egbuna et al, 2006 ). CMV and PVB19 infections have been reported in transplant recipients with PTA and may cause pure red cell aplasia (PRCA) (Pinto et al, 2008 ). Viral infections (CMV, EBV, influenza A, and human heprus virus 6 and 8) can also cause HPS (a rare cause of PTA) and HUS in transplant recipients (Asaka et al, 2000 ; Maakaroun et al, 2010 ).…”

Section: Post-transplant Anemia (Pta)mentioning

confidence: 99%

Blood disorders typically associated with renal transplantation

Yang

Chen³

2015

Front. Cell Dev. Biol.

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Renal transplantation has become one of the most common surgical procedures performed to replace a diseased kidney with a healthy kidney from a donor. It can help patients with kidney failure live decades longer. However, renal transplantation also faces a risk of developing various blood disorders. The blood disorders typically associated with renal transplantation can be divided into two main categories: (1) Common disorders including post-transplant anemia (PTA), post-transplant lymphoproliferative disorder (PTLD), post-transplant erythrocytosis (PTE), and post-transplant cytopenias (PTC, leukopenia/neutropenia, thrombocytopenia, and pancytopenia); and (2) Uncommon but serious disorders including hemophagocytic syndrome (HPS), thrombotic microangiopathy (TMA), therapy-related myelodysplasia (t-MDS), and therapy-related acute myeloid leukemia (t-AML). Although many etiological factors involve the development of post-transplant blood disorders, immunosuppressive agents, and viral infections could be the two major contributors to most blood disorders and cause hematological abnormalities and immunodeficiency by suppressing hematopoietic function of bone marrow. Hematological abnormalities and immunodeficiency will result in severe clinical outcomes in renal transplant recipients. Understanding how blood disorders develop will help cure these life-threatening complications. A potential therapeutic strategy against post-transplant blood disorders should focus on tapering immunosuppression or replacing myelotoxic immunosuppressive drugs with lower toxic alternatives, recognizing and treating promptly the etiological virus, bacteria, or protozoan, restoring both hematopoietic function of bone marrow and normal blood counts, and improving kidney graft survival.

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Severe Anemia From Parvovirus B19 Infection in Pediatric Renal Transplant Recipients: Two Case Reports

Cited by 15 publications

References 15 publications

Frequent occurrence of parvovirus B19 DNAemia in the first year after kidney transplantation

Frequent occurrence of parvovirus B19 DNAemia in the first year after kidney transplantation

Drug-Induced Hematological Cytopenia in Kidney Transplantation and the Challenges It Poses for Kidney Transplant Physicians

Blood disorders typically associated with renal transplantation

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