肝移植后微小病毒B19感染致纯红细胞再生障碍性贫血三例及文献复习

Human parvovirus B19 infection-associated anemia after liver transplantation: three case reports with a literature review

目的探讨成人肝移植术后微小病毒B19(HPV-B19)感染所致纯红细胞再生障碍性贫血(PRCA)的临床诊断和治疗。方法回顾性分析南昌大学第一附属医院器官移植科3例成人肝移植术后因HPV-B19感染引起受者PRCA的临床资料。复习国内外相关文献, 整理肝移植术后感染HPV-B19的检测方法及治疗方案。结果 3例受者均因终末期肝病行肝移植, 术中输血量较大, 术后恢复顺利。出院后1~2个月出现重度贫血, 再次入院后排除失血性贫血, 经骨髓穿刺和宏基因测序诊断为PRCA。经降低免疫抑制治疗的强度, 使用静脉注射用免疫球蛋白(IVIG)7~10 d, 血红蛋白很快恢复正常。总结近年来国内外肝移植术后HPV-B19感染的文献15篇, 诊治方案有趋同性。结论 HPV-B19感染可引起成人肝移植术后的PRCA发生, 使用宏基因测序早期诊断的同时, 静脉注射免疫球蛋白并调整免疫抑制剂方案可能是现在最为可行的治疗方案。

Objective To explore the diagnosis and treatment of pure red cell aplastic anemia(PRCA)caused by parvovirus B19(HPV-B19)infection after liver transplantation(LT).Methods Three adult PRCA patients caused by parvovirus B19 infection after LT were reviewed retrospectively.The relevant literatures were collected to sort out the detection methods and treatment of parvovirus B19 infection after LT.Results All three patients received liver transplantation due to end-stage liver disease with massive intraoperative blood transfusion and smooth postoperative recovery.Severe anemia occurred at 1-2 Months after discharge.Hemorrhagic anemia was excluded after re-admission and PRCA was diagnosed by bone marrow aspiration and next generation sequencing(NGS).After tapering the intensity of immunosuppressive therapy,intravenous immunoglobulin(IVIG)was administered for 7-10 days and hemoglobin soon normalized.A review of 15 recent literatures on HPV-B19 infection after LT revealed that the diagnosis and treatment of parvovirus B19 infection after LT gradually were became same.Conclusions HPV-B19 infection causes PRCA after LT in adults.Diagnosing with NGS,intravenous injection of immunoglobulin and modification of immunosuppressant regimen may achieve excellent therapeutic efficacies.