Parvovirus-Associated Anemia in a Renal Transplant Recipient Adolescent

Anemia is a frequent problem in renal transplant recipients, the most frequent cause being erythropoietin deficiency due to allograft failure. Parvovirus B19 can cause persistent viremia and erythropoietin resistant erythroid aplasia in immunosuppressed patients. On the other hand, it can cause allograft dysfunction in renal transplant recipients. A male patient with end-stage renal failure due to Alport syndrome received a renal transplant at 17 years of age. A triple immunosuppressive treatment with prednisolone, tacrolimus and mycophenolate mofetil was then initiated. A graft biopsy was performed because of >30% increase in serum creatinine and development of anemia (Hb 6,9 g/dL) during the early postransplant period, but it was not consistent with acute rejection. Anemia-related assessments revealed reticulocytopenia and erythroid aplasia on bone marrow aspiration. Blood parvovirus B19 PCR level was found to be 7.270.278.211 IU/mL. Immunosuppressive drug doses were held constant and IVIG treatment was instituted for 5 days. After this treatment, the hemoglobin level increased to 10.0 mg/dl and 13.2 mg/dL at the 2nd week and 2nd month, respectively. In conclusion, when anemia develops in renal transplant recipients in the absence of rejection and hemolysis, parvovirus infection should be considered.