Pure Red Cell Aplasia in a Kidney Transplant Recipient with Parvovirus B19 Infection

Justiniano J.Y.V.; Vilca K.M.; Butron M.; Bendezu D.Z.V. · Revista Colombiana de Nefrologia (2026) · DOI: 10.22265/acnef.13.2.1014

Resumen

Background: Anemia is a common complication following kidney transplantation, with an estimated incidence of 40 % to 50 % of patients during the first three months after the procedure. This condition significantly impacts both graft and patient survival. The most common causes of post-transplant anemia include iron and/or folate deficiency, impaired erythropoiesis secondary to bone marrow suppression induced by immunosuppressive therapy (both induction and maintenance), the use of prophylactic antimicrobial agents, and infectious processes, particularly viral infections such as parvovirus B19. Purpose: To describe a case of pure red cell aplasia secondary to parvovirus B19 infection in a kidney transplant recipient. Case presentation: We report the case of a 35-year-old male who four weeks after kidney transplantation presented a progressive decline in hemoglobin levels requiring repeated red blood cell transfusions. Hematologic evaluation, bone marrow aspiration and biopsy, revealed pure red cell aplasia. Concurrently, parvovirus B19 PCR DNA quantification showed an exceptionally high viral load (244,280,959,800 IU/mL; log 11.39). Based on these findings, treatment with intravenous immunoglobulin (IVIG) was initiated leading to clinical improvement. One month later, the patient developed a recurrence of symptomatic anemia with reticulocytopenia, needing a second IVIG course, which resulted in sustained hematologic recovery. Conclusion: Parvovirus B19 infection should be considered in kidney transplant recipients with severe anemia and persistent reticulocytopenia. Timely diagnosis by PCR and treatment with intravenous immunoglobulin, combined with adjustment of immunosuppression, can lead to sustained hematologic recovery and prevent potential effects on the graft.

Instituciones: Universidad Peruana Cayetano Heredia