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2010-03-23-16 Anemia caused by Parvovirus B19 infection © Cuillier www.TheFetus.net

Parvovirus B19 infection, Anemia

Fabrice Cuillier, MD.

Service de Gynécologie-Obstétrique, Hôpital Félix Guyon, Saint-Denis de La Réunion, France.


Introduction

This is a case of a 30-year-old G2P1 with unremarkable personal or family history. Her previous pregnancy was uneventful. This current pregnancy was developing normally. The first trimester ultrasound scan was normal with NT measuring 1 mm. The triple test was negative.

The ultrasound scan at 22 weeks of gestation revealed the following findings:
  • cardiomegaly with myocardial hypertrophy
  • bilateral pleural effusion
  • ascites
  • anhydramnios
At 24 weeks of gestation the ultrasound findings were identical. The maternal serology was positive for Parvovirus B19 (both IgM and IgG antibodies). Patient told us about a skin eruption which occurred 6 weeks ago.

The Doppler of the middle cerebral artery showed increased peak systolic velocity which was a sign of anemia caused by the Parvovirus infection. We decided for the intrauterine therapy of fetal anemia and administered 5 ml of packed red blood cells into the umbilical vein. The hemoglobin level before the transfusion was 6g/ml and increased up to 13g/ml after the transfusion.

Subsequent ultrasound revealed decrease of the peak systolic velocity of the middle cerebral artery. At 25 weeks of gestation the peak systolic velocity was 45 cm/s and it decreased  to 35 cm/s at 28 weeks. The ascites slowly disappeared during the course of next 4 weeks. We didn't see any signs of cardiomegaly 6 weeks after the transfusion.

MRI of the fetal brain performed at 32 weeks of gestation did not reveal any abnormality. We diagnosed bilateral club foot which developed as a result of a long lasting anhydramnios.

Patient delivered vaginally at 37 weeks of gestation. The neonate's weight was 1950 grams and the physical examination  was normal except of previously diagnosed club foot. The hemoglobin level after delivery was 17 g/ml.

Images 1,2: Image 1 shows cardiomegaly and pleural effusion. Image 2 shows ascites.
 


Images 3,4
: Image 3 shows ascites. Image 4 shows shows a Doppler imaging, note the increased peak systolic velocity of the middle cerebral artery.



Images 5-8: Doppler of the middle cerebral artery after the intraumbilical transfusion of the packed red blood cells. The peak systolic velocity was slowly decreasing.





Image 9,10: Image 9 shows a Mari's chart demonstrating fetal anemia (X axis shows the peak systolic velocity of the middle cerebral artery, Y axis shows a gestational age).

 

Images 11,12: Images show that cardiomegaly and pleural effusion diminished after administration of the intraumbilical red blood cell transfusion.




 

 

 
 
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