Status:
Ready to upload
Record number:
1445
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Case report
Time to detection:
8-12 days
Alerting signals, symptoms, evidence of occurrence:
A skin rash and elevated temperature of 40C was detected 8 days after administration of 230mg/kg/d of intravenous immune globulin (IVIG). Three days later, hepatic function began to deteriorate with abnormal coagulation and pancytopenia.The patient became drowsy and her blood ammonia level rose to 62 micromoles/l. Bone marrow examination showed erythroid specific aplasia suggesting human parvovirus B19 infection. A serum sample was positive for B19 IgM antibody and B19 DNA.
Demonstration of imputability or root cause:
Bone marrow examination showed erythroid specific aplasia suggesting human parvovirus B19 infection. A serum sample was positive for B19 IgM antibody and B19 DNA. IVIG batches that were administered to the patient were positive for B19 DNA by PCR. It could not be confirmed that the B19 contamination caused the fulminant hepatitis due to the presence of a concurrent Coxsackie B4 infection.
Imputability grade:
3 Definite/Certain/Proven
Groups audience:
Keywords:
References:
Suggest new keywords:
IVIG, intravenous immune globulin, hepatitis, erythroid aplasia, coagulopathy, ammonia
Reference attachment:
Suggest references:
Hayakawa, F., Imada, K., Towatari, M. and Saito, H. (2002). Life-threatening human parvovirus B19 infection transmitted by intravenous immune globulin. Br J Haemotol 118(4):1187-89.