Intravenous immunoglobulin treatment of congenital parvovirus B19 induced anemia - a case report

• Published in: Maternal health, neonatology and perinatology Vol. 9; no. 1; p. 10
• Main Authors: Aronson, Stephanie T, Celiker, Mahmut Y, Guarini, Ludovico, Agha, Rabia
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07-08-2023; BioMed Central; BMC
• Subjects: Anemia; Antibodies; Blood; Bone marrow; Care and treatment; Case Report; Case reports; Children & youth; Congenital anemia; Congenital diseases; Congenital parvovirus infection; Emergency medical care; Erythrocytes; Fetal anemia; Fetuses; Genetic disorders; Health aspects; Hemoglobin; Hydrops fetalis; Immunoglobulins; Infants; Infants (Premature); Infection; Infections; Intensive care; IVIG; Medical examination; Neonatal intensive care; Parvovirus B19; Perinatal infection; Placenta; Polymerase chain reaction; Pregnancy; Pregnant women; Sepsis; Transfusion; Fetal anemia; Congenital anemia; Perinatal infection; Hydrops fetalis; Parvovirus B19; IVIG; Congenital parvovirus infection; Neonatal anemia
• ISSN: 2054-958X; 2054-958X
• DOI: 10.1186/s40748-023-00164-2

Parvovirus is a common childhood infection that could be very dangerous to the fetus, if pregnant women become infected. The spectrum of effects range from pure red blood cell aplasia with hydrops fetalis to meningoencephalitis, with many symptoms in between. Severe anemia in the setting of pure red blood cell aplasia is one of the more common effects that neonatal experience (if infected intrapartum), with the current gold standard treatment being intrauterine or postnatal packed red blood cell (PRBC) transfusions, yet intravenous immunoglobulin (IVIG) may be a superior treatment option.
A preterm infant was born at 26th week of gestational age via emergency Cesarean section due to hydrops fetalis, with parvovirus B19 exposure one month prior. The infant tested positive for IgM antibodies against parvovirus B19. Among many other serious complications of both hydrops fetalis and premature delivery, the infant had severe unremitting anemia, and received many PRBC transfusion over the course of his 71-day-long neonatal intensive care unit stay. During a follow up appointments as outpatient, his blood tests showed persistent high copies of parvovirus B19. He was then supported with PRBC transfusions and treated with IVIG. After three doses of IVIG, the infant's parvovirus B19 viral copy numbers have dramatically reduced and the infant did not require any more PRBC transfusions.
IVIG infusion effectively treated the parvovirus B19 infection and restored erythropoiesis making the child transfusion independent. Furthermore, since IVIG is safe and readily crosses the placenta, further studies are needed to determine if IVIG should be considered as an alternative prenatal treatment for congenital parvovirus B19 infection.