Parvovirus Infection Causing Aplastic Anaemia in an Immunocompetent Patient Diagnosed by Bone Marrow Aspiration Cytology

Abstract

Human Parvovirus infection is associated with transient aplastic crisis as a most common complication in chronic haemolytic anaemia patients. Very few case reports are available regarding aplastic crisis in immunocompetent patients. Here the authors are reporting a case of 17-year-old immunocompetent male that presented with fever, headache for three days. Complete blood count showed pancytopenia. Bone marrow aspiration and trephine biopsy revealed hypocellularity. Giant pro-erythroblasts with multiple cytoplasmic projections (dog ear appearance) and prominent intranuclear inclusions were seen in marrow aspirated cytology. Classical cytological findings in bone marrow aspiration raised the suspicion of human parvovirus infection. Findings were confirmed by positive Deoxyribonucleic Acid Polymerase Chain Reaction (DNA PCR) for parvovirus B19 and parvovirus Immunoglobulin M (IgM) antibody using Enzyme Linked Immunosorbent Assay (ELISA) test. Patient was managed with antibiotic therapy and was trasfused three units of blood. Complete blood count became normal after two months. This emphasises the role of keeping high index of suspicious for Parvovirus B19 infection as a cause of aplastic anaemia even in individual without underlying diseases. Secondly characteristic morphological changes in the erythroid precursors in the bone marrow aspiration is highly suggestive of Parvovirus B19 infection.

Keywords

• dog ear appearance
• erythroblasts
• haemolytic anaemia
• polymerase chain reaction
• trephine biopsy