IVIG Therapy May Fight Parvovirus-Associated Pure Red Cell Aplasia

Intravenous immunoglobulin (IVIG) therapy can be used to promote antibody formation against parvovirus-associated pure red cell aplasia (PRCA) and helps compliance with antiretroviral therapy (ART) and proton pump inhibitors (PPI), which helps manage anemia, new study results show.

IVIG therapy is often used as a treatment and can reverse PRCA with antibodies that protect against parvovirus, with a regimen of doses as low as 400 mg/kg over a 2-to-5-day period.

A routine immunohistochemical staining is crucial to determine whether an individual has parvovirus, because of an individual testing negative with a polymerase chain reaction (PCR) test and positive with an immunohistochemical staining, investigators said.

In a study of an individual with PRCA, the individual had low levels of hemoglobin and was noncompliant with ART regimens.

Tests showed the individual was tachycardic to 106 beats per minute and had a hematocrit level of 7.5%, a mean corpuscular volume of 95.4 fL, and a low reticulocyte percentage of 0.2. Folate values, leukocyte count, liver function, platelet count, and vitamin B12 levels were normal.

The individual had a low total iron-binding capacity level, and the abdomen and pelvis did not have any actively bleeding lesions.

A PPI drip was used to help the blood loss from previous gastrointestinal bleeding, and 4 units of blood were transfused.

The individual was treated with a 14-day course of amoxicillin, clarithromycin, and PPI to treat PRCA. A bone marrow biopsy was used to evaluate the potential for hypoproliferative.

The individual had a negative quantitative PRC for parvovirus. However, an immunohistochemical staining was positive for parvovirus.

All the tests were consistent with parvovirus-induced PRCA.

The individual received a 5-day course of IVIG as per hematology recommendations, with stabilization of hemoglobin at 8.8 g/dL when discharged.

ART was used after discharge, and the individual was doing clinically well at the 2-month follow-up.

Management of PRCA involves transfusions, treatment of any underlying disorders, and immunosuppressive or immunomodulatory therapy for those with anemia, investigators said.

With parvovirus-induced PRCA, the use of IVIG proves to be an effective method of treatment.

Reference

Joseph KD, Thota V, Bains A, et al. Exploring the rare etiology of severe anemia in an immunocompromised patient. Cureus. 2021;13(7):e16750.doi:10.7759/cureus.16750