To the Editor.—
In a recent issue, Lefrere and Decazes1 presented the clinical observation of thrombocytopenia with or without leukopenia occurring in 16 of 29 patients with underlying hemolytic anemia and human parvovirus B19—associated "aplastic crisis," supporting the hypothesis that the pathology caused by B19 infection is not confined to the erythroid compartment.2 Whereas B19 has previously been shown in vitro to inhibit erythroid colony formation and to replicate in erythroid cells,3 laboratory evidence to explain the occurrence of thrombocytopenia and neutropenia observed in some cases of B19 infection has so far been lacking. Kurtzman et al4 have now demonstrated the presence of B19 DNA exclusively associated with high-density cells after Ficoll-Hypaque separation of peripheral blood from a B19-infected patient who had no circulating normoblasts. Erythroid hypoplasia remains the principal clinical observation and focus of concern in persons with hemolytic anemia who are infected with B19.
Chorba T. Aplastic Crisis or Erythroid Hypoplasia?. JAMA. 1987;257(15):2034. doi:10.1001/jama.1987.03390150050025