Clinical and laboratory manifestations and outcomes of human parvovirus B19 infections in sickle cell anemia with emphasis on the impact of hydroxyurea.

OBJECTIVES

This study aim to assess the clinical and laboratory features and outcomes of human parvo B19 (HPVB19) infection in patients with sickle cell anemia (SCA), with particular emphasis on impact of hydroxyurea (HU) therapy.

METHODS

After institutional ethical approval, data from 124 patients with SCA with were confirmed to have HPVB19 (via DNA viral load testing) were retrospectively analyzed.

RESULTS

The mean age for our cohort was 23.3 years (range 2-57 years). Splenectomy was noted in 27.4%, and splenomegaly in 54%. HU use was used in 31.5% of patients. HPVB19 infection led to significant reductions in red blood cell, hemoglobin, white blood cell, and platelet counts (P <0.05). All patients tested positive for HPVB19 immunoglobulin M and viral DNA; 62% also had immunoglobulin G. The median viral load was 263,000 × 10⁶ copies/ml. Blood transfusions were required in 84.7% of cases. Transient red cell aplasia occurred in 12.1%, requiring 84 units of blood (mean 5.6 units per patient). Complications included hepatic failure (nine), renal failure (five), fat embolism syndrome (four), multiorgan failure (one), and death in two patients (1.6%). Although HU use was associated with lower white blood cell nadirs, there was no significant impact on hospital stay, transfusion needs, or major hematologic parameters. There was fewer complications and shorter hospital stays, hinting at possible protective benefits of HU.

CONCLUSIONS

HPVB19 infection in patients with SCA can lead to transient aplastic crisis, pancytopenia, and serious complications, underlining the need for prompt diagnosis and management. HU seems to have protective effect against severe HPVB19 infection.