nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2020-24-2-72-79nefr-1802Research ArticleНАБЛЮДЕНИЯ ИЗ ПРАКТИКИPRACTICAL NOTESТяжёлая анемия, вызванная парвовирусом B19, у пациентки с функционирующим ренальным трансплантатом: клиническое наблюдениеSevere anemia caused by parvovirus B19 in a patient with functioning kidney transplant: case reporthttps://orcid.org/0000-0002-7686-9816ПрокопенкоЕ. И.ProkopenkoE.

Проф. Прокопенко Елена Ивановна, д-р мед. наук.

Факультет усовершенствования врачей, кафедра трансплантологии, нефрологии и искусственных органов.

129110, Москва, ул. Щепкина, д. 61/2Тел.: (495)6845791 

Prof. Elena I. Prokopenko MD, PhD, DMedSci.

Postgraduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2Phone: (495)6845791

renalnephron@gmail.comhttps://orcid.org/0000-0003-4388-7759КантарияР. О.KantariyaR. O.

Доц. Кантария Русудана Отаровна, канд. мед. наук.

Факультет усовершенствования врачей, кафедра трансплантологии, нефрологии и искусственных органов.

129110, Москва, ул. Щепкина, д. 61/2Тел.: (495)6845791 

Associate prof. Rusudana O. Kantariya MD, PhD.

Postgraduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2Phone: (495)6845791

rusiko_k@mail.ruhttps://orcid.org/0000-0001-8497-0693ВатазинА. В.VatazinA. V.

Проф. Ватазин Андрей Владимирович, д-р мед. наук.

Факультет усовершенствования врачей, кафедра трансплантологии, нефрологии и искусственных органов.

129110, Москва, ул. Щепкина, д. 61/2Тел.: (495)6845453 

Prof. Andrey V. Vatazin MD, PhD, DMedSci.

Postgraduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2Phone: (495)6845453

vatazin@yandex.ruhttps://orcid.org/0000-0002-4057-4661ПасовС. А.PasovS. A.

Проф. Пасов Сергей Алексеевич, д-р мед. наук.

Факультет усовершенствования врачей, кафедра трансплантологии, нефрологии и искусственных органов.

129110, Москва, ул. Щепкина, д. 61/2Тел.: (495)6845791 

Prof. Sergey A. Pasov MD, PhD, DMedSci

Postgraduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2Phone: (495)6845791

pasovsa@yandex.ruМосковский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоРоссияM.F. Vladimirsky Moscow Regional Research Clinical InstituteRussian Federation2020080220202427279Copyright © Прокопенко Е.И., Кантария Р.О., Ватазин А.В., Пасов С.А., 20202020Прокопенко Е.И., Кантария Р.О., Ватазин А.В., Пасов С.А.Prokopenko E., Kantariya R.O., Vatazin A.V., Pasov S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1802

Инфекция, вызванная парвовирусом B19 (PV B19), может вызывать у реципиентов ренального трансплантата парциальную красноклеточную аплазию (ПККА) и тяжёлую нормохромную анемию, резистентную к лечению эритропоэтином. Активная парвовирусная инфекция развивается обычно в первые месяцы после трансплантации почки (ТП), но не всегда сопровождается клинической симптоматикой. Частота PV B19-ассоциированной анемии невысока – не более 1–1,5 %. Подтверждением этиологии заболевания, помимо характерной гистологической картины костного мозга (снижение числа эритрокариоцитов менее 5 % при сохранном миелопоэзе и мегакариопоэзе, появление единичных гигантских пронормобластов), является обнаружение ДНК PV B19 в крови и/или костном мозге. Обнаружение специфических антител класса IgM к парвовирусу играет менее значимую роль в подтверждении активной инфекции PV B19 у пациентов после ТП, получающих иммуносупрессивную терапию, и не должно использоваться как единственный метод диагностики. Специфического противовирусного лечения инфекции PV B19-инфекции не существует, поэтому применяются другие подходы к терапии: редукция иммуносупрессии, трансфузии эритроцитной массы, введение внутривенного иммуноглобулина (ВВИГ). В статье описывается клиническое наблюдение пациентки 33 лет с ХБП 5 стадии, у которой через 4 нед после успешной ТП развилась тяжелая нормохромная анемия, резистентная к лечению эритропоэтином. При цитологическом исследовании костного мозга выявлена ПККА, а в крови пациентки обнаружено большое число копий ДНК PV B19, при этом антитела к парвовирусу IgG и IgM не выявлялись. Снижение иммуносупрессии (отмена микофеноловой кислоты), повторное введение ВВИГ в суммарной дозе 147 г привело через 5 мес лечения к стойкой нормализации числа эритроцитов и уровня гемоглобина. При этом функция ренального трансплантата в течение всего периода наблюдения оставалась нормальной.

Parvovirus B19 (PV B19) infection can cause pure red cell aplasia (PRCA) and severe normochromic anemia resistant to treatment with erythropoietin in renal transplant recipients. Active parvovirus infection usually develops in the first months after kidney transplantation (KT), but is not always accompanied by clinical symptoms. The incidence of PV B19-associated anemia is low - not more than 1–1.5 %. A confirmation of the etiology of the disease, in addition to the characteristic histological picture of the bone marrow (a decrease in the number of erythrokaryocytes of less than 5% with preserved myelopoiesis and megakaryopoiesis, the appearance of single giant pronormoblasts), is the detection of PV B19 DNA in the blood and / or bone marrow. The detection of specific IgM antibodies to parvovirus plays a less significant role in the diagnosis of active PV B19 infection in patients after KT receiving immunosuppressive therapy and should not be used as the only diagnostic method. There is no specific antiviral treatment for PV B19 infection, therefore other approaches to therapy are used: reduction of immunosuppression, transfusion of red blood cells, administration of intravenous immunoglobulin (IVIG). The article describes the clinical observation of a 33-year-old patient with stage 5 CKD who developed severe normochromic anemia resistant to treatment with erythropoietin 4 weeks after a successful KT. A cytological examination of the bone marrow revealed PRCA, and a large number of copies of PV B19 DNA were detected in the patient’s blood, while antibodies to parvovirus IgG and IgM were not revealed. A decrease of immunosuppression (withdrawal of mycophenolic acid), repeated administration of IVIG in a total dose of 147 g resulted to lasting normalization of red blood cells number and hemoglobin level after five months of treatment. The function of the renal transplant remained normal throughout the observation period.

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The authors declare that there are no conflicts of interest present.