title: Parvovirus B19 infection presenting with severe erythroid aplastic crisis during pregnancy in a woman with autoimmune hemolytic anemia and alpha-thalassemia trait: a case report.
abstract: BACKGROUND
  Parvovirus B19 virus commonly causes subclinical infection, but it can prove fatal to the fetus during pregnancy and cause severe anemia in an adult with hemolytic diseases. We present the case of a woman with autoimmune hemolytic anemia who was diagnosed with parvovirus B19-induced transient aplastic crisis during her second trimester of pregnancy and faced the high risk of both fetal and maternal complications related to this specific viral infection. To the best of our knowledge, the experience of successful intravenous immunoglobulin treatment for B19 virus infection during pregnancy, as in our case, is limited.
  
  
  METHODS
  A 28-year-old and 20-week pregnant Chinese woman with genetically confirmed alpha-thalassemia trait was diagnosed with cold antibody autoimmune hemolytic anemia and suffered from transient aplastic crisis caused by B19 virus infection. She received intravenous immunoglobulin treatment to reduce the risk of hydrops fetalis. Her peripheral blood reticulocyte percentage recovered, but anemia persisted, so she underwent several courses of high dose intravenous dexamethasone for controlling her underlying hemolytic problem. Finally, her hemoglobin levels remained stable with no need of erythrocyte transfusion, and a healthy baby boy was naturally delivered.
  
  
  CONCLUSIONS
  Parvovirus B19 virus infection should be considered when a sudden exacerbation of anemia occurs in a patient with hemolytic disease, and the possible fetal complications caused by maternal B19 virus infection during pregnancy should not be ignored. Close monitoring and adequate management can keep both mother and fetus safe.
authors.affiliation: Department of Internal Medicine, Feng Yuan Hospital, No. 100, Ankang Road, Fengyuan District, Taichung City, 420, Taiwan. chan0118@msn.com.
authors.forename: Chi-Ching
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Department of Gynecology and Obstetrics, Feng Yuan Hospital, No. 100, Ankang Road, Fengyuan District, Taichung City, 420, Taiwan. chinsun42@yahoo.com.tw.
authors.forename: Chin-Shan
authors.initials: CS
authors.lastname: Chen
authors.affiliation: Section of Infectious Disease, Department of Internal Medicine, Feng Yuan Hospital, No. 100, Ankang Road, Fengyuan District, Taichung City, 420, Taiwan. wywang1996@ndmctsgh.edu.tw.
authors.forename: Wei-Yao
authors.initials: WY
authors.lastname: Wang
authors.affiliation: Department of Pediatrics, Feng Yuan Hospital, No. 100, Ankang Road, Fengyuan District, Taichung City, 420, Taiwan. jma052968@gmail.com.
authors.forename: Jui-Shan
authors.initials: JS
authors.lastname: Ma
authors.affiliation: Department of Anatomical Pathology, Feng Yuan Hospital, No. 100, Ankang Road, Fengyuan District, Taichung City, 420, Taiwan. wendyshu@fyh.mohw.gov.tw.
authors.forename: Hwei-Fan
authors.initials: HF
authors.lastname: Shu
authors.affiliation: Division of Hematology/Oncology, Department of Internal Medicine, Feng Yuan Hospital, No. 100, Ankang Road, Fengyuan District, Taichung City, 420, Taiwan. fantast.fan@msa.hinet.net.
authors.forename: Frank S
authors.initials: FS
authors.lastname: Fan
mesh_terms: D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications* / Q000473:pathology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D010322:Parvoviridae Infections / Q000150:complications / Q000188:drug therapy*; D016732:Parvovirus B19, Human; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011251:Pregnancy Complications, Infectious; D017085:alpha-Thalassemia / Q000150:complications*
chemical_list: D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D003907:Dexamethasone