Morning Report 6/28/2010 (2 days of residency left!

)
Cindy Bader MD
 Parvovirus B-19

most often presents as erythema infectiousum/ 5th’s disease

frequently causes a nonspecific viral syndrome in children or adults

may cause arthritis & arthralgias (hands, wrists and knees)

high seropositivity rates in adults, even without a hx of 5th’s ds

may lead to pregnancy complications

may cause aplastic crisis in patients with an underlying RBC disorder

Erythema Infectiousum

most common presentation of disease

in children

rash preceded by low-grade fever,

malaise

“slapped cheek” and faint,

evanescent, lacy red rash on trunk and
limbs

highest rates in 7-10 y.o. children

 Aplastic Crisis

parvovirus (small DNA virus) has a predeliction for rapidly growing cells,
especially erythroid precursors

any patient with a chronic hemolytic anemia at risk (sickle cell, hereditary
spherocytosis, thalassemia etc.)

infection leads to an acute drop in the reticulocyte production, which in the

setting of chronic ongoing hemolysis can lead to severe acute anemia

if not recognized and treated with transfusion may develop signs/symptoms

of heart failure
Hereditary Spherocytosis

the most common disorder of the

red blood cell membrane

characterized by chronic
hemolysis

typically mild requiring no

treatment

severe anemia, jaundice and

splenomegaly in severe cases
 Diagnosing Hereditary
Spherocytosis
exam: splenomegaly, jaundice, frontal bossing (extramedullary
hematopoesis)

smear: spherocytes

CBC: normal to decreased Hgb (mild, moderate or severe)

reticulocyte count: typically elevated

elevated LDH/ hyperbilirubinemia

confirmation: osmotic fragility test

 Managing Hereditary
Spherocytosis

serial Hgb/Hct and reticulocyte counts

serial abdominal exams (spleen size)

transfusions for moderate to severe cases

splenectomy for severe cases (indications for

splenectomy remain controversial)