Transient erythroblastopenia of childhood

Transient erythroblastopenia of childhood (TEC) is a rare disorder characterized by a sudden decrease in red cell production,

Fig. 7.3. Bone marrow from a 16-year-old girl with human parvovirus B19 infection leading to marked anemia with reticulocytopenia, leukopenia, and thrombocytopenia. The parvovirus infection was confirmed serologically by the presence of elevated IgM and negative IgG at the time of diagnosis. This was followed by a seroconversion several months later and a resolution of the peripheral blood cytopenias. (A) Bone marrow aspirate shows a paucity of erythroid progenitors and rare giant proerythroblasts. (B, C) Examples of giant proerythroblasts with intranuclear inclusions and a moderate amount of basophilic cytoplasm with irregular cytoplasmic borders. Cytoplasmic vacuolization may be present (Wright-Giemsa stain).

Manifested by anemia with reticulocytopenia, followed by a spontaneous recovery within one to two months [21]. TEC is most frequent in children between four months and four years of age, and it is usually associated with pure red cell aplasia. However, accompanying white blood cell and platelet abnormalities may also be present [22, 23].

Tte etiology of TEC is still unknown. Immune-mediated mechanisms and viral infection, such as human herpesvirus 6 (HHV-6) or parvovirus B19, although reported have not been proven [24-27]. A growing body of evidence suggests that TEC occurs as a result of environmental exposure to an unknown agent in genetically predisposed individuals. Rarely, siblings with TEC, or a family history of anemia suggesting an underlying genetic susceptibility transmitted in an autosomal dominant pattern, have been reported [28].

During the recovery phase, the peripheral blood shows an improvement of the anemia, marked reticulocytosis, and high

MCV. At that time, the red blood cells have some characteristics of fetal erythrocytes, such as high MCV, increased Hb F production, and the presence of i antigen. As a result, distinguishing TEC from other forms of congenital pure red cell aplasia, such as DBA, may be difficult. Unlike DBA, the erythrocytes in TEC have normal eADA levels.

Tte prognosis of TEC is excellent. tte disease is self-limited and rarely requires transfusion or bone marrow examination. TEC should be suspected in otherwise healthy children with anemia and reticulocytopenia and no other abnormalities suggestive of leukemia or other specific disease.

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