LQCL2617 - CMLE - Chronic Parvovirus B19 Infection Masking Potential Hyperhemolysis in an Adult Sickle Cell Patient: A Case Study of Transfusion-Related Anemia and Reaction Complications-LQCL2617

LQCL2617 - Educational Activity

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This transfusion medicine case study describes a 56-year-old woman with homozygous sickle cell disease (HbSS) and extensive comorbidities, including orthotopic liver transplant on tacrolimus, chronic parvovirus B19 infection, and chronic kidney disease, admitted with profound symptomatic anemia (hemoglobin 4.6 g/dL). Despite treatment for chronic parvovirus (foscarnet and IVIG), she continued to experience recurrent anemia. She received two units of O-negative RBCs on April 15, 2025 without incident. On April 17, 2025, during transfusion of an additional O-negative RBC unit for hemoglobin 5.0 g/dL, she developed a fever to 38.7°C after ~100 mL infused; the transfusion was stopped and a reaction workup initiated.<br /><br />Clerical checks confirmed correct patient/unit identification and ABO compatibility (patient B positive; donor O negative). There was no visible hemolysis. Pre- and post-transfusion DAT remained weakly positive for IgG (1+), while reference testing showed negative eluate and negative C3, arguing against a newly formed clinically significant alloantibody or complement-mediated hemolysis. Urinalysis showed increased intact RBCs without hemoglobinuria, supporting hematuria rather than intravascular hemolysis.<br /><br />The document reviews how parvovirus B19 targets and lyses erythroid progenitor cells, causing erythroid aplasia and transient aplastic crisis in patients with chronic hemolytic anemia, and how immunosuppression can lead to persistent infection that mimics other post-transfusion anemia etiologies. Hyperhemolysis syndrome remains a key differential in sickle cell patients because it can cause hemoglobin to fall below baseline by destroying both transfused and autologous RBCs, but typical findings (hemoglobinuria, markedly elevated bilirubin/LDH, clear laboratory evidence of hemolysis) were absent here. The case resolution concludes the episode most consistent with a febrile nonhemolytic transfusion reaction (FNHTR), with recommendations for antipyretics, monitoring for infection/hemolysis, careful observation in future transfusions, and culture of the residual unit to exclude bacterial contamination.

Keywords

transfusion medicine

sickle cell disease HbSS

febrile nonhemolytic transfusion reaction (FNHTR)

parvovirus B19 chronic infection

symptomatic severe anemia

direct antiglobulin test (DAT) IgG positive

hyperhemolysis syndrome differential

O-negative red blood cell transfusion

immunosuppression tacrolimus liver transplant

bacterial contamination workup blood culture