IVIG Therapy Can Fight Against Parvovirus-Associated Pure Red Cell Aplasia

A study finds that intravenous immunoglobulin therapy is a beneficial way to combat parvovirus-induced PRCA in individuals with anemia.

Intravenous immunoglobulin (IVIG) therapy can be used to promote antibody formation against parvovirus-associated pure red cell aplasia (PRCA) and helps with adherence to antiretroviral therapy (ART) and proton pump inhibitors (PPI), which helps to manage an individual’s anemia, according to a study published in The Cureus Journal of Medical Science.

IVIG therapy is a frequently used treatment that can reverse PRCA with antibodies that protect against parvovirus, with a regimen of doses as low as 400 mg/kg over a 2-to-5-day period.

The study authors said that routine immunohistochemical staining is crucial to determine whether an individual has parvovirus or not, due to the individual testing negative with a PCR test and positive with an immunohistochemical staining.

In a study of an individual with PRCA, the individual had low levels of hemoglobin and was noncompliant with ART regimens.

Tests revealed the individual was tachycardic to 106 beats per minute, hematocrit of 7.5%, mean corpuscular volume of 95.4 fL, and low reticulocyte percentage of 0.2. Liver function, leukocyte count, platelet count, vitamin B12, and folate values levels were normal.

The individual had low total iron-binding capacity level and the abdomen and pelvis did not have any actively bleeding lesions.

A PPI drip was used to help the blood loss from previous gastrointestinal bleeding and 4 units of blood were transfused.

The individual was treated with a 14-day course of clarithromycin, amoxicillin, and PPI to treat PRCA. A bone marrow biopsy was used to evaluate the potential hypoproliferative.

The individual had a negative quantitative polymerase chain reaction for parvovirus, however an immunohistochemical staining was positive for parvovirus. All the tests were consistent with parvovirus-induced PRCA.

The individual received a 5-day course of IVIG as per hematology recommendations with stabilization of hemoglobin at 8.8 g/dL when discharged.

ART was used after discharged and the individual was doing clinically well at the two-month follow-up.

The study authors also state that management of PRCA involves transfusions, treatment of any underlying disorders, and immunosuppressive or immunomodulatory therapy for those with anemia.

With parvovirus-induced PRCA, the use of IVIG was found to be an effective method of treatment, according to the study.


JosephKD, ThotaV, BainsA, PatelNS, MustaqeemR, Mulla S, ThirumaranR, Trawinski J. Exploring the rare etiology of severe anemia in an immunocompromised patient. The Cureus Journal of Medical Science. 2021;13(7):e16750.doi: 10.7759/cureus.16750.

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