Viruses and Hematologic Disorders

Identify viral infections associated with cytopenias

Parvovirus B19, EBV, CMV, HIV, HBV, HCV

Most common viral cause of aplastic crisis in sickle cell disease

Parvovirus B19

Why Parvovirus B19 causes cytopenias

Targets erythroid progenitors → halts RBC production

Classic rash of Parvovirus B19 in children vs adults

Slapped‑cheek rash (erythema infectiosum) in kids

Polyarthropathy in adults(arthritis)

Parvovirus B19 bone marrow finding

Giant pronormoblasts

Parvovirus B19 diagnosis in immunocompetent host

IgM serology

Parvovirus B19 diagnosis in immunocompromised host

PCR for viral DNA

Treatment for Parvovirus B19 in immunocompromised host

IVIG

Define infectious mononucleosis syndrome

Fever, pharyngitis, LAD, HSM, atypical lymphocytes, cytopenias

Most common cause of infectious mononucleosis

EBV

EBV hematologic findings

Absolute lymphocytosis with >10% atypical lymphocytes

EBV heterophile antibody test

Monospot (positive in most adolescents)

EBV serology for acute infection

VCA‑IgM positive, EBNA negative

EBV complications

Splenic rupture, AIHA, airway obstruction

EBV association with malignancy

Burkitt lymphoma, Hodgkin lymphoma, nasopharyngeal carcinoma

CMV mononucleosis heterophile test

Negative

CMV mononucleosis hematologic findings

Relative lymphocytosis with <10% atypical lymphocytes

CMV diagnosis

IgM serology or PCR; Owl eyes on histo

CMV treatment in immunocompromised host

Ganciclovir or valganciclovir

Most severe respiratory virus in immunocompromised pts

Influenza

Influenza treatment

Oseltamivir, zanamivir, peramivir, baloxavir

Herpes zoster complications in ICH

Dissemination, pneumonitis, hepatitis, encephalitis

Herpes zoster treatment

Acyclovir, valacyclovir, famciclovir

Key feature distinguishing EBV vs CMV mono (lymphocytes)

EBV >10% atypical lymphs

Key feature distinguishing EBV vs CMV lymphadenopathy

EBV prominent cervical LAD