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LETTER TO THE EDITOR
Year : 2018  |  Volume : 21  |  Issue : 4  |  Page : 227-228

Benefits of human parvovirus B19 testing in sickle cell anemic patients and blood donors in Nigeria


1 Department of Medical Microbiology and Parasitology, College of Health Sciences, University of Ilorin, Ilorin; Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
2 Department of Obstetrics and Gyaenacology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
3 Department of Microbiology, Faculty of Science, Federal University, Dutse, Jigawa State, Nigeria
4 Department of Medicine (Immunology unit), Ahmadu Bello University, Zaria, Kaduna State, Nigeria

Date of Web Publication31-Dec-2018

Correspondence Address:
Mr. Idris Abdullahi Nasir
Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, FCT Abuja
Nigeria
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DOI: 10.4103/smj.smj_40_17

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How to cite this article:
Nasir IA, Zakari MM, Idris A, Ahmad AE. Benefits of human parvovirus B19 testing in sickle cell anemic patients and blood donors in Nigeria. Sahel Med J 2018;21:227-8

How to cite this URL:
Nasir IA, Zakari MM, Idris A, Ahmad AE. Benefits of human parvovirus B19 testing in sickle cell anemic patients and blood donors in Nigeria. Sahel Med J [serial online] 2018 [cited 2019 May 26];21:227-8. Available from: http://www.smjonline.org/text.asp?2018/21/4/227/249080



Dear Sir,

Human parvovirus B19 (B19V) is known to show singular tropism and lytic infection of erythroid progenitor cells which may consequently result in transient red cell aplasia and chronic anemia.[1] Nigeria has the highest prevalence of sickle cell anemia (SCA) in Sub-Saharan Africa.[2] Unfortunately, the role of B19V in the pathogenesis and clinical complications among SCA patients remains unclear in Nigeria, especially in the northern part of the country. Considering the significantly high transmissibility and prevalence of B19V, many SCA patients could have been transfused with red cells infected with B19V. Unfortunately, these donated bloods are neither tested nor treated for B19V.[3] This consequently increases the risk of circulatory collapse due to severe anemia. Despite being a country that is highly burdened by SCA, data defining the burden of parvovirus B19 infections in the general population and SCA subpopulation are scanty.[4]

Globally, B19V is a common viral pathogen. Serosurveys indicate that >50% of people were infected during childhood, but higher number of cases are observed among SCA children in some tropical countries.[5] For instance, a Brazilian study reported 80% seroprevalence of B19V in children between 5 and 15 years[6] and 55% in Australian children.[7] B19V outbreaks occur repetitively at 3–4-year intervals.[8] These outbreaks have a major impact on the development of Transient red cell aplasia (TRAC) among patients with various forms of hereditary hemoglobinopathies.[8]

It was previously thought that anti-B19V antibodies make B19V less infectious, and consequently, the transfusion of positive B19V-infected blood was considered a safe procedure.[5],[8] This notion has been contradicted by the discovery of several viral genotypes and the transfusion transmission of B19V in spite of the presence of antibodies and the severity of the clinical picture in SCA patients. Hence, B19V is now considered easily transmitted by blood transfusion.[5],[8]

The few prevalence data of B19V in SCA patients and blood donors were from Lagos, Jos, and Zaria cities of Nigeria. In a study, anti-parvovirus B19 IgM and IgG antibodies were detected in 22 (14.3%) and 97 (62.9%) of the 154 sera screened, 13 (17.8%), and 45 (61.6%) in SCA patients; 9 (11.1%) and 52 (64.2%) in non-SCA controls.[4] Parvovirus B19 DNA was found in 2 (11.1%) of the 18 IgM seropositive SCA serum samples screened,[4] whereas in a comparative cross-sectional study at Lagos, Iheanacho et al. reported that 99 (66%) and 2 (1.3%) blood donors were anti-B19V IgG and IgM, respectively, while 92 (61.3%) and 8 (5.3%) SCA patients were anti-B19V IgG and IgM positive, respectively.[9]

In another study, Ujo et al. reported that 204 (85.4%) SCA patients were positive for IgG antibodies against parvovirus B19. In addition, age group with the highest prevalence was those within 10–12 years with age-stratified seroprevalence of 88.9%.[10] Alao et al. reported 39.5% seroprevalence of B19V IgG in SCA children attending Jos Teaching Hospital.[11] In epidemiological context, SCA is estimated on the average to affect 2% of the Nigerian population, which translates to about 3 million people in the country.[12]

Acute B19V infection is serologically diagnosed in humans as positive anti-parvovirus IgM and molecularly by the detection of viral DNA in the serum using polymerase chain reaction (PCR).[13],[14] The presence of anti-parvovirus B19 IgG in the serum is indicative of humoral immunity to the previous viral infection.[14] Serological tests used for B19V investigations/diagnosis have limitations, such as requests for acute-phase sampling, possibility of false-positive or false-negative results, cross reactions to antibodies to related viruses, low IgM threshold detectable level, and need for further serum sampling to confirm serodiagnosis. In light of these, the PCR-based techniques give better and more reliable results within 24 h of B19V viremia.[14]

As part of the ongoing global research efforts aimed at ascertaining risk factors of frequent sickle cell crisis, there is a need to explore the prevalence of B19V in SCA patients and their corresponding blood donors, thereby establishing a cost–benefit relationship of the need to test for B19V to prevent its transmission in SCA patients that needed blood transfusion in every affected country of the world.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Luo Y, Kleiboeker S, Deng X, Qiu J. Human parvovirus B19 infection causes cell cycle arrest of human erythroid progenitors at late S phase that favors viral DNA replication. J Virol 2013;87:12766-75.  Back to cited text no. 1
    
2.
Adewoyin AS. Management of sickle cell disease: A review for physician education in Nigeria (sub-Saharan Africa). Anemia 2015;2015:791498.  Back to cited text no. 2
    
3.
Schmidt M, Themann A, Drexler C, Bayer M, Lanzer G, Menichetti E, et al. Blood donor screening for parvovirus B19 in Germany and Austria. Transfusion 2007;47:1775-82.  Back to cited text no. 3
    
4.
Iwalokun BA, Iwalokun SO, Hodonu SO. Seroprevalence of parvovirus B19 antibodies and evidence of viremia among Nigerian patients with sickle cell anemia. J Biomed Res 2013;27:272-82.  Back to cited text no. 4
    
5.
Serjeant GR, Topley JM, Mason K, Serjeant BE, Pattison JR, Jones SE, et al. Outbreak of aplastic crises in sickle cell anaemia associated with parvovirus-like agent. Lancet 1981;2:595-7.  Back to cited text no. 5
    
6.
Amaku M, Azevedo RS, Castro RM, Massad E, Coutinho FA. Relationship among epidemiological parameters of six childhood infections in a non-immunized Brazilian community. Mem Inst Oswaldo Cruz 2009;104:897-900.  Back to cited text no. 6
    
7.
Kelly HA, Siebert D, Hammond R, Leydon J, Kiely P, Maskill W. The age-specific prevalence of human parvovirus immunity in Victoria, Australia compared with other parts of the world. Epidemiol Infect 2000;124:449-57.  Back to cited text no. 7
    
8.
Slavov SN, Kashima S, Pinto AC, Covas DT. Human parvovirus B19: General considerations and impact on patients with sickle-cell disease and thalassemia and on blood transfusions. FEMS Immunol Med Microbiol 2011;62:247-62.  Back to cited text no. 8
    
9.
Iheanacho MC, Akanmu SA, Nwogoh B. Seroprevalence of parvovirus B19 antibody in blood donors and sickle cell disease patients at Lagos university teaching hospital (LUTH): A comparative study. Afr J Clin Exp Microbiol 2014;15:14-20.  Back to cited text no. 9
    
10.
Ujo A, Mamman AI, Aliyu A, Ogunrinde GO. The seroprevalence of parvovirus antibodies among children with sickle cell anaemia in Zaria. Afr J Clin Exp Microbiol 2012;13:74-8.  Back to cited text no. 10
    
11.
Alao OO, Girei AI, Joseph DE, Banwat EB, Araoye MO, Orkuma J, et al. Effect of socio-demographic variables on anti-parvovirus B19 antibody seropositivity among children with sickle cell anaemia in Jos, North Central Nigeria. Internet J Epidemiol 2009;8:1-5.  Back to cited text no. 11
    
12.
Akinkugbe OO, editor. Sickle cell disease. In: Non-Communicable Diseases in Nigeria. Lagos: Federal Ministry of Health; 1992. p. 45-52.  Back to cited text no. 12
    
13.
Juwah AI, Nlemadim EU, Kaine W. Types of anaemic crises in paediatric patients with sickle cell anaemia seen in Enugu, Nigeria. Arch Dis Child 2004;89:572-6.  Back to cited text no. 13
    
14.
Corcoran A, Doyle S. Advances in the biology, diagnosis and host-pathogen interactions of parvovirus B19. J Med Microbiol 2004;53(Pt 6):459-75.  Back to cited text no. 14
    




 

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