Hemoglobin

Transient Red Cell Aplasia

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Transient Red Cell Aplasia, Aplastic Crisis in Sickle Cell Anemia, Parvovirus B19 Infection in Sickle Cell Anemia

  • See Also
  1. Sickle Cell Anemia
  2. Acute Chest Syndrome
  3. Acute Vaso-Occlusive Episode in Sickle Cell Anemia
  4. Aplastic Crisis in Sickle Cell Anemia
  5. Cerebrovascular Accident in Sickle Cell Anemia
  6. Dactylitis in Sickle Cell Anemia (Hand Foot Syndrome in Sickle Cell Anemia)
  7. Hematuria in Sickle Cell Anemia
  8. Osteomyelitis in Sickle Cell Anemia
  9. Priapism in Sickle Cell Anemia
  10. Pulmonary Hypertension in Sickle Cell Anemia
  11. Septic Arthritis in Sickle Cell Anemia
  12. Sickle Cell Anemia Related Pulmonary Hypertension
  13. Sickle Cell Anemia with Splenic Sequestration
  • Pathophysiology
  1. Parvovirus B19 infection interrupts Red Blood Cell production by affecting erythroid precursors in marrow
  2. Results in high Red Blood Cell turn-over
  • Symptoms
  1. Weakness
  2. Shortness of Breath
  3. Fever
  • Signs
  1. May be fully compensated with normal Heart Rate and Blood Pressure
  2. Pallor
  3. Tachycardia
  4. Hypotension
  • Labs
  1. Hemoglobin decreased from baseline
    1. Severe Anemia (esp. in children)
  2. Reticulocyte Count decreased (<1% during aplastic crisis)
    1. Secondary to decreased Red Blood Cell production despite acute Anemia
    2. Contrast with Sickle Cell Hemolytic Crisis and Splenic Sequestration where the Reticulocyte Count is increased
  • Differential Diagnosis
  1. Septic Shock
  2. Sickle Cell Hemolytic Crisis
  3. Splenic Sequestration
  • Management
  1. Admit with isolation droplet precautions (due to Parvovirus B19)
    1. Avoid exposing pregnant women
  2. Consult hematology
  3. Intravenous Immunoglobulin (IVIG)
  4. Blood Transfusion may be needed
    1. Blood should be cross-matched, Leukocyte depleted, and irradiated
    2. If stable, avoid Fluid Overload by slow infusion over 4 hours
    3. Plan to raise Hemoglobin by 1 g/dl
  • Course
  1. Aplasia typically resolves over 1-2 weeks
  2. After infection resolution, Immunity to Parvovirus B19 reduces risk of recurrent aplastic crisis
  • Complications
  1. Vaso-Occlusive Pain Crisis
    1. May be triggered by Aplastic Crisis
  • References
  1. Glassberg and Weingart in Majoewsky (2012) EM: Rap 12(8): 5-6
  2. Lowe and Wang (2018) Crit Dec Emerg Med 32(11): 17-25