PARVO B19 Virus (Marilyn)

Parvo B19 Virus (Slap Cheek or 5th Disease) has the ability to shut down Red Cell production in the bone marrow.  Though less likely to impact normal healthy people.  It may be more of a danger to those dealing with a low immune system or other negative health issues.

In a normal otherwise healthy patient, those patients can even end up with a Red Cell Production Shut Down.  But while possible, it would be rare.

In fact normal healthy people might not even think much about some minor symptoms of a low fever and rosy red cheeks. Or “Slap Cheek”, which is a common term for Parvo B19.

But when Red Cell production is shut down.  The shut down condition may be transient, and hopefully so.   Lasting a week to 10 days.  The chance Red Cell production never starts back up, is a possibility though.

In a CAD’s case, they are dealing constantly with Hemolytic Anemia, or at least Hemolysis that is in excess of normal Red Cell die off.

Where CAD’s typically have excessive Red Cell destruction going on.  At the same time, they have an above normal, to high, Retic Rate.  [ Retic is the rate at which the bone marrow is creating new replacement Red Cells.]

So if Red Blood Cell destruction is going on, and Retic is high.  These two factors may play a balancing act  of the Red Blood Cell Count [RBC] that might be normal, low end of normal, or in ranges lower, than that of a normal healthy person.  This lower RBC may even be considered “Normal” for a given CAD.

If the CAD patient has kept warm and things as far a RBC remain constant.  Their health and test indicators may remain constant.  This balanced RBC level as indicated, might be considered the “CAD Normal” range for this individual CAD.  Though certainly not so called “normal” for a healthy non-CAD person.

The so called “normal” for a CAD may vary wildly from CAD to CAD. It is unpredictable in advance.  Often a trial and error type of monitoring, or determining the CAD’s stable point.

When a CAD starts into a crisis of a falling Red Cell count (from their “normal”), especially when this seems accelerated over a very short time frame.  Hgb levels, and Retic need to be re-evaluated.

Keeping detailed records (copies) of all your Blood Testing results will benefit you in times of crisis.

Excessive Cold exposures would obviously be the first suspect in the case of a rapidly falling Red Blood Cell Count (hgb).  If there has been a recent long exposure, or repeated exposures accelerating Red Cell Destruction due to CAD.

With this might come one with one of the visual indicators of discolored skin issues, or dark urine.  An indication of excessive hemolysis.  But that is only a maybe.

What If there hasn’t been above normal  cold exposures to overly activate CAD and accelerate hemolysis?

Where Red Cell Destruction has not accelerated.  But perhaps Red Cell Production (Retic) has slowed or ceased?  You might have to suspect a virus or some other trigger.  If Retic rate has fallen to below your “normal”, or has completely shut down?   In this case, there may be no excessive hemolysis, which would then stand to reason, there would be no dark urine indicator or warning.  But Hgb could still be falling.

You/your medical team may have to then suspect something that is now impacting your Retic rate.  Not Hemolysis.  There could be a combination of both negatives happening too.

Not only things like known viruses that shut down Retic.  But other things like Iron or Vitamin B12 deficiencies?  Both Iron and B12 are used by the bone marrow to produce new Red Blood Cells [Retic].

What if your Iron and B12 are normal but Retic has slowed or stopped?

Viruses might be a prime suspect.

Parvo B19 virus is one of numerous causes, that can have a serious impact on a CAD patient’s Retic.  Not just a CAD, but those in general with immune issues.

Parvo B19 does have the potential to cause the bone marrow to completely shut down Red Cell Production [Retic shut down].  This creates a secondary Anemic condition that is categorized as Aplastic Anemia.

There are specific IgM and IgG anti-B19 antibodies that would test positive (ELISA).  If this was the cause.  But it does require testing, and a savvy doctor to initiate that.  Regretfully a “wait and see’ approach is often taken after some treatment is attempted.

If indeed your accelerated Red Blood Count (RBC decreasing) is due to Parvo Virus.  It may run its course and in the process, shut down Red Cell production.  That shut down typically lasts a week to ten days.

During this “RBC production shut down” time frame, especially in a CAD who’s own immune system is already destroying Red Cells.  It may be impossible for the patient to ride this out unassisted.  Blood Transfusions more than likely would be required to maintain safe levels of red blood cells in the body.  Most likely resulting in a ICU type of situation.

In some cases Procrit can/is given to help stimulate red cell production and or help trigger startup.

Then hopefully the body will start “Retic’ing” around a week to ten days.  After the Parvo virus runs its course.

Additional Notes

Procrit can/is given to help stimulate red cell production startup.

Transfusions given to bridge the anemic period when no Red Cell Production is happening.

Should only get Parvo B19 once in a lifetime.  Antibodies should be created naturally once your body fights it.

There are specific antibodies to test for.  IgM & IgG anti-B19

Marilyn had it (Parvo B19 Virus) a second time.  The 2nd bout was 5 years after the first event.  Rituxan treatment was in between.  Rituxan was suspected of stripping her antibodies.  During both events she experienced complete shut down of Red Blood Cell production and she had to be transfused with plasma.

IVIG infusions were used (after 2nd bout with Parvo) in an attempt to restore other possible missing antibodies that Rituxan may have stripped away.  She had a vast improvement after IVIG as far as not getting every cold that was passed around.