Parvovirus B19 infection and unresponsiveness to erythropoietin therapy in haemodialysis patients.

and on apical grade-2 holosystolic murmur was audIntroduction ible. Abdominal examination were normal. He had a bilateral ankle swelling. The Hb concentration was Human parvovirus (HPV ) was isolated from blood in 4.5 g/dl, Hct 15%, RBC 1 780 000/mm3, WBC 1970 [1]. Infection with parvovirus B19 has been 2300/mm3, platelets 127 000/mm3, reticulocyte count associated with a variety of clinical syndromes, includ0.1% and serum iron 40 mg/dl (Table 1). Tests for ing fifth disease (also known as erythema infechaemolytic disorders and for occult blood were negatiousum), polyarthralgia syndrome [2]. Another tive. An antibody capture assay to detect HPV IgG complication of this infection is transient aplastic crisis and IgM antibody was performed (Parvovirus IgG in patients with underlying chronic hemolytic disorders EIA and IgM mu-capture EIA; Biotrin international, [3–6 ]. Additionally, pure red cell anemia due to chronic USA). There was no antivirus IgG in capture immunoparvovirus B19 infection has rarely been described in assay. But IgM antibodies for HPV were positive. organ transplant recipients [7]. Because of red blood Despite an increased dose of erythropoietin (175 cell survival is significantly reduced, aplastic crisis may U/kg) anaemia progressed. Two units of blood were occur in uraemic patients similar to the cases with transfused. Iron therapy (ferrous sulfate 270 mg, twice hemolytic anaemia. We describe one patient with per day) was initiated. In the weeks following his uraemia who had HPV induced aplastic crisis. hospitalization for aplastic crisis, fever, sore throat, fatigue, and muscle weakness had returned to normal. Two weeks later, haematocrit increased to 20.3. He Case report was discharged home in good condition. One month later, his haematocrit was 29.6%, WBC A 17-year-old man with end-stage renal failure due to 3800/mm3, platelet 183 000/mm3. Antiparvovirus IgM chronic glomerulonephritis, who had been treated by and IgG antibody were present in the patients serum. haemodialysis (three times in a week) for 35 months. Repeat antiparvovirus IgG antibody detection were He received 500 mg calcium carbonate three times/day positive, however antiparvovirus IgM was undetectable during meals, 0.5 mg/day of vitamin 3 and subcutaneously administered erythropoietin 50 U/kg, twice in a week. Laboratory tests, one week before the HPV Table 1. Laboratory findings of patients with aplastic crisis infection showed haemoglobin (Hb) 10.7 g/dl, haematocrit (Hct) 36.9%, red blood cells (RBC) 3 050