ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO872

Parvovirus Red Blood Cell Aplastic Anemia in a Kidney Transplant Patient

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Khaja, Taqui, Houston Methodist Hospital, Houston, Texas, United States
  • Amini, Shayan, Houston Methodist Hospital, Houston, Texas, United States
  • Edwards, Angelina, Houston Methodist Hospital, Houston, Texas, United States
Introduction

Anemia is common in kidney transplant patients and is linked with increased risk of patient mortality, reduced graft survival, and a decline in allograft function. There are multiples etiologies, and iron deficiency is the main contributor. However, viral infections are often overlooked and can lead to significant anemia post-transplantation. We report a unique case of parvovirus B19 infection leading to pure red blood cell aplasia in a kidney transplant patient.

Case Description

This is a 62- year- old Hispanic man with end stage kidney disease and dialysis dependence presumed secondary to diabetes and hypertension. He received a living related kidney transplant in December 2021. He was deemed low-immunologic risk and underwent induction with basiliximab. He was maintained on tacrolimus, mycophenolate, and prednisone. He attained excellent allograft function with nadir creatinine of 1.1 mg/dL.

On February 2022, he was admitted to the hospital for symptomatic anemia with hemoglobin of 6.5 g/dL with low reticulocyte index of 0%. Evaluation was negative for GI blood loss, hemolysis, or iron/vitamin B12/folate deficiencies. Supportive blood transfusion was given and he was discharged with outpatient follow-up but remained transfusion dependent.


Parvovirus B19 quantitative serum PCR was obtained and his viral load was greater than 5,000,000 copies. Patient was promptly treated 5 doses of IV IgG and his mycophenolate dosage was reduced. Since then, his hemoglobin as continued to improve without blood transfusions and his parvovirus B19 viral load has reduced substantially to 7,249 copies as of April 2022. He is followed closely by his nephrologist and hematologist.

Discussion

Parvovirus infection can cause refractory anemia in kidney transplant patients and this problem can progress to transfusion dependence. Incidence rate of anemia from parvovirus can occur up to 23% of renal transplant patients. Diagnosis is confirmed with PCR assay. Treatment consists of IV IgG and reduction in immunosuppression, specifically antiproliferative agents like mycophenolate. Relapse of anemia is common. Effectiveness of therapy is based on improvement in anemia. This disease should be considered when encountering refractory anemia during the post-transplantation period.