Hemoglobin

Transient Red Cell Aplasia

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Transient Red Cell Aplasia, Aplastic Crisis in Sickle Cell Anemia

  • 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
  • Differential Diagnosis
  1. Sickle Cell Hemolytic Crisis
  2. Splenic Sequestration
  • Symptoms
  • 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
  2. Reticulocyte Count decreased (approaches 0)
    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
  • 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
  • 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