L A Chambers1, A M Rauck. 1. Department of Laboratory Medicine, Children's Hospital and Ohio State University, Columbus 43205, USA.
Abstract
PURPOSE: A case of childhood acute hemolytic anemia following parvovirus infection provided an hypothesis for the high frequency of Donath-Landsteiner antibodies and inappropriately low reticulocyte counts in this disease. PATIENTS AND METHODS: A 3-year-old boy with hematuria and jaundice was found to have autoimmune hemolytic anemia due to a biphasic IgG Donath-Landsteiner antibody. Despite profound anemia (hematocrit 14.5%), the reticulocyte count was low (1.0%) and examination of his normocellular bone marrow showed erythroid hypoplasia. RESULTS: A clinical diagnosis 2 weeks earlier of acute parvovirus B19 was serologically confirmed as the associated antecedent infection. Hemolytic anemia resolved with packed red cell transfusion, and intravenous immune globulin and steroid treatment. CONCLUSIONS: The high-frequency red cell P antigen is both the unusual specificity of Donath-Landsteiner antibody and the viral receptor for parvovirus infection of red cell precursors. We speculate that interaction of the virus with its receptor may change antigenicity such that anti-P autoantibody forms. Parvovirus B19 may be a primary cause of reticulocytopenic postinfectious hemolytic anemia in children.
PURPOSE: A case of childhood acute hemolytic anemia following parvovirus infection provided an hypothesis for the high frequency of Donath-Landsteiner antibodies and inappropriately low reticulocyte counts in this disease. PATIENTS AND METHODS: A 3-year-old boy with hematuria and jaundice was found to have autoimmune hemolytic anemia due to a biphasic IgG Donath-Landsteiner antibody. Despite profound anemia (hematocrit 14.5%), the reticulocyte count was low (1.0%) and examination of his normocellular bone marrow showed erythroid hypoplasia. RESULTS: A clinical diagnosis 2 weeks earlier of acute parvovirus B19 was serologically confirmed as the associated antecedent infection. Hemolytic anemia resolved with packed red cell transfusion, and intravenous immune globulin and steroid treatment. CONCLUSIONS: The high-frequency red cell P antigen is both the unusual specificity of Donath-Landsteiner antibody and the viral receptor for parvovirus infection of red cell precursors. We speculate that interaction of the virus with its receptor may change antigenicity such that anti-P autoantibody forms. Parvovirus B19 may be a primary cause of reticulocytopenic postinfectious hemolytic anemia in children.
Authors: Annie J Kruger; Chaoxing Yang; Sun W Tam; Douglas Hinerfeld; James E Evans; Karin M Green; John Leszyk; Kejian Yang; Dennis L Guberski; John P Mordes; Dale L Greiner; Aldo A Rossini; Rita Bortell Journal: Exp Biol Med (Maywood) Date: 2010-11