Table 2. Parvovirus B19 infection presentation and investigations.
| Patient 1 | Patient 2 | Patient 3 | |
|---|---|---|---|
| Time of parvovirus infection posttransplant | 8 wk | 7 wk | 11 wk |
| Presentation | Dizziness, dyspnea on exertion, dark stools | Dizziness, dark stools | Dizziness, dyspnea on exertion, palpitation |
| Physical exam | HR, 89; BP, 134/74; RR, 18; Temp, 98, SpO2, 96% | HR, 100; BP, 130/54; RR, 18, Temp, 98.6; SpO2, 98% | HR, 86; BP,110/68; RR,18; Temp, 98.4; SpO2, 98% |
| Investigations: blood | Hb, 6.6; Hct, 19.6; RBC count, 2.34; TC, 4,600; Plt, 295, RBC indices, normal | Hb, 7.1; Hct, 21.2; RBC count, 2.31; TC, 6,300; Plt, 419; RBC indices, normal | Hb, 6.3; Hct, 18.4; RBC count, 2.22; TC, 4,600; Plt, 320; RBC indices, normal |
| Reticulocyte count, 0.3% | Reticulocyte count, 0.2% | Reticulocyte count, 0.2% | |
| RBS, 230; Na, 140; K, 4.1; Cl, 106; HCO3, 21 | RBS, 86; Na, 137; K,4.5; Cl, 105; HCO3, 20 | RBS, 113; Na, 130; K,4.7; Cl, 100; HCO3, 21 | |
| BUN/Cr, 31/1.51 | BUN/Cr, 20/1.27 | BUN/Cr, 13/1.1 | |
| LDH, 134 | LDH, 188 | LDH, 144 | |
| Iron studies-increased iron and ferritin, decreased TIBC | Iron studies-normal iron, increased ferritin, decreased TIBC | Iron studies-increased iron and ferritin, decreased TIBC | |
| Haptoglobin, normal; B12 and folate, normal | Haptoglobin, normal; B12 and folate, normal | Haptoglobin, normal; B12 and folate, normal | |
| Urinalysis, no proteinuria | Urinalysis, no proteinuria | Urinalysis, no proteinuria | |
| Others | FOB, negative | FOB, positive | Not indicated |
| CT abdomen-no evidence of bleeding | CT abdomen-no evidence of bleeding | CT abdomen-no evidence of bleeding | |
| OGD-erosive gastropathy | OGD-normal | Not indicated | |
| Colonoscopy- normal | Colonoscopy-pan colitis | Not indicated | |
| Initial management | Aspirin stopped and patient monitored for bleeding. In spite of no active bleeding, Hb continued to drop rapidly and Parvovirus infection was suspected | Treated conservatively for colitis, no further bleeding but Hb continued to drop, BMA done and showed erythroid aplasia. Renal biopsy was done due to rise in creatinine and it showed hydropic changes in tubular epithelial cells | Hb continued to drop, BMA done which showed erythroid aplasia. |
| Detection of parvovirus | Positive PCR | Bone marrow study, positive PCR | Positive PCR, positive IgM serology, bone marrow study |
| Co infections | CMV PCR positive, EBV antigen positive | EBV antigen positive | CMV PCR positive |
| Lowest Hb level after diagnosis | 6 | 6.2 | 6 |
| Highest Cr level after diagnosis | 1.74 | 2.25 | 1.3 |
Abbreviations: BP, blood pressure (mm Hg); BMA, bone marrow aspiration; BUN, blood urea nitrogen (mg/dL); Cl, chloride (mEq/L); CMV, cytomegalovirus; Cr, creatinine (mg/dL); EBV, Epstein-Barr virus; FOB, fecal occult blood; Hb, hemoglobin (g/dL); HCO3, bicarbonate (mEq/L); Hct, hematocrit (%); HR, heart rate (no of beats/min); K, potassium (mEq/L); LDH, lactate dehydrogenase (IU/L); Na, sodium (mEq/L); OGD, esophagoduodenoscopy; PCR, polymerase chain reaction; Plt, platelet; RBS, random blood sugar (mg/dL); RBC, red blood cells; RR, respiratory rate (per min); TC, total count; Temp, temperature (°F); TIBC, total iron binding capacity.