P.139: A rare cause of severe anemia following kidney transplantation.

Abstract

Background: Anemia is common in post kidney transplant patient due to multifactorial cause. In a well-functioning graft anemia usually resolve with few months. Here we describe a rare cause of severe anemia following kidney transplant. Case: A 20 year old young gentleman came in with end stage renal failure with uremia of unknown cause. After two years of dialysis he received a live donor kidney transplant. He received induced Simulect for induction and maintained on tacrolimus, mycophenolate mofetil and prednisolone. Post transplant course was uneventful. A month later he was noted to have decline in hemoglobin. Despite erythropetin therapy it progressively declined, reached to its nadir 4.8 gm/dl a month later (Fig .1). He required few units of blood transfusion. In the meantime tests for Hemolysis markers, substrate deficiency (Iron, Vitamin B12 and folate) were all negative. Bone marrow aspiration demonstrated erythroid hypoplasia with occasional giant proerythroblast which is suspicious of parvo B19. Though serology both IgG and IgM were negative, qualitative PCR were positive for Parvo B19 Virus. Four doses of intravenous immunoglobulin administered besides reduction of immunosuppressant ion. Within two weeks’ time the anemia remarkably sustained improvement. Allograft function was stable throughout. Discussion: Anemia is well-recognized complication post kidney transplantation due to multifactorial etiology. Parvo infection is a rare but significant cause severe anemia in immunosuppressed patients such as kidney transplant patient. Serology tests might be deceiving in immunosuppressed patients to diagnose the infection due to inadequate humoral response as in our case. Detection of viral DNA by PCR, though it qualitative with the clinical setting and suggestive BM aspiration likely to be active infection. Conclusions: Parvo B19 though rare is an important treatable cause of severe anemia after kidney transplant. There should be high index of suspicion of Parvo B19 infection in severe anemia following kidney transplant.