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Transient Erythroblastopenia of Childhood Clinical Presentation

  • Author: Lennox H Huang, MD, FAAP; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
 
Updated: Mar 20, 2014
 

History

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  • Most individuals with transient erythroblastopenia of childhood (TEC) present with gradually increasing pallor and no other symptoms despite the severity of the anemia.
  • Occasionally, parents report increased fatigue or decreased energy levels in children with transient erythroblastopenia of childhood.
  • Some isolated incidents of transient neurologic events and breath-holding spells have been reported in association with transient erythroblastopenia of childhood.
  • Other differential considerations (eg, aplastic crises, hyperhemolytic crises, sequestrations) typically present more acutely than transient erythroblastopenia of childhood. Fatigue and pallor develop over the course of days and are often associated with nonspecific viral symptoms, such as fever, malaise, lethargy, abdominal pain, or upper respiratory symptoms. Jaundice may also be a presenting symptom, especially in the context of a preexisting hemoglobinopathy such as sickle cell disease or hereditary spherocytosis.
  • Family history may reveal siblings with a history of anemia.
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Physical

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  • Upon physical examination, patients are usually healthy except for findings commonly associated with anemia, such as skin and mucosal pallor, tachycardia, and, often, a cardiac flow murmur.[6] There is one isolated case report of TEC in association with ectopic atrial tachycardia.[7]
  • By contrast, the most common congenital anomalies associated with Diamond-Blackfan anemia include short stature, low birth weight, developmental delay, thumb malformations, craniofacial anomalies, and urogenital abnormalities. Examining for physical anomalies is important because they are found in as many as 70% of patients with Diamond-Blackfan anemia.
  • A complete neurologic examination is necessary because of case-report associations.
  • In patients with symptoms such as splenomegaly and icterus, consider other diagnoses such as a hemolytic-associated anemia or sequestration-associated anemia. A characteristic "slapped cheek" rash is often associated with parvovirus B19 infection and aplastic anemia.[8]
  • There is one isolated case report of TEC in association with neonatal hepatitis.[9]
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Causes

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  • The cause of transient erythroblastopenia of childhood is unknown. Viral and immunologic mechanisms may be involved.
  • Reports of seasonal clusters of incidents of transient erythroblastopenia of childhood, although suggestive of a viral etiology, are not statistically significant.
  • Only a handful of familial transient erythroblastopenia of childhood cases have been reported, and no apparent genetic link has been elucidated.
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Contributor Information and Disclosures
Author

Lennox H Huang, MD, FAAP Associate Professor and Chair, Department of Pediatrics, McMaster University School of Medicine; Chief of Pediatrics, McMaster Children's Hospital

Lennox H Huang, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Physician Leadership, Canadian Medical Association, Ontario Medical Association, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Robin Miller 

Disclosure: Nothing to disclose.

Carol Portwine, MD, PhD FRCP, FAAP, Associate Professor, Department of Pediatrics, Division of Hematology/Oncology, McMaster University

Carol Portwine, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, Canadian Medical Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada, Canadian Paediatric Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

James L Harper, MD Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Associate Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology, American Federation for Clinical Research, Council on Medical Student Education in Pediatrics, Hemophilia and Thrombosis Research Society, American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology

Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA Executive Vice President, Chief Medical and Academic Officer, Renown Heath

Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American College of Healthcare Executives, American Society of Pediatric Hematology/Oncology, Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Sharada A Sarnaik, MBBS Professor of Pediatrics, Wayne State University School of Medicine; Director, Sickle Cell Center, Associate Hematologist/Oncologist, Children's Hospital of Michigan

Sharada A Sarnaik, MBBS is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, New York Academy of Sciences, Society for Pediatric Research, Children's Oncology Group, American Academy of Pediatrics, Midwest Society for Pediatric Research

Disclosure: Nothing to disclose.

References
  1. Prassouli A, Papadakis V, Tsakris A, et al. Classic transient erythroblastopenia of childhood with human parvovirus B19 genome detection in the blood and bone marrow. J Pediatr Hematol Oncol. 2005 Jun. 27(6):333-6. [Medline].

  2. Geetha D, Zachary JB, Baldado HM, et al. Pure red cell aplasia caused by Parvovirus B19 infection in solid organ transplant recipients: a case report and review of literature. Clin Transplant. 2000 Dec. 14(6):586-91. [Medline].

  3. Skeppner G, Kreuger A, Elinder G. Transient erythroblastopenia of childhood: prospective study of 10patients with special reference to viral infections. J Pediatr Hematol Oncol. 2002 May. 24(4):294-8. [Medline].

  4. Shaw J, Meeder R. Transient erythroblastopenia of childhood in siblings: case report and review of the literature. J Pediatr Hematol Oncol. 2007 Sep. 29(9):659-60. [Medline].

  5. Chabali R. Transient erythroblastopenia of childhood presenting with shock and metabolic acidosis. Pediatr Emerg Care. 1994 Oct. 10(5):278-80. [Medline].

  6. Schinasi DA, Schapiro E, Shah M. Ectopic atrial tachycardia in an infant with transient erythroblastopenia of childhood. Pediatr Emerg Care. 2011 Jul. 27(7):657-9. [Medline].

  7. Schinasi DA, Schapiro E, Shah M. Ectopic atrial tachycardia in an infant with transient erythroblastopenia of childhood. Pediatr Emerg Care. 2011 Jul. 27(7):657-9. [Medline].

  8. Ergül Y, Nisli K, Kelesoglu F, Dindar A. Acute pericarditis and transient erythroblastopenia associated with human parvovirus B19 infection. Turk Kardiyol Dern Ars. 2010 Jul. 38(5):349-51. [Medline].

  9. Moritake H, Hidaka F, Kamimura S, Kojima H, Shimonodan H, Nunoi H. Concomitant transient erythroblastopenia of childhood with neonatal hepatitis. Pediatr Int. 2012 Feb. 54(1):147-50. [Medline].

  10. Martinez Barrio A, Eriksson O, Badhai J, et al. Targeted resequencing and analysis of the Diamond-Blackfan anemia disease locus RPS19. PLoS One. 2009 Jul 9. 4(7):e6172. [Medline]. [Full Text].

  11. Chan GC, Kanwar VS, Wilimas J. Transient erythroblastopenia of childhood associated with transient neurologic deficit: report of a case and review of the literature. J Paediatr Child Health. 1998 Jun. 34(3):299-301. [Medline].

  12. Cherrick I, Karayalcin G, Lanzkowsky P. Transient erythroblastopenia of childhood. Prospective study of fifty patients. Am J Pediatr Hematol Oncol. 1994 Nov. 16(4):320-4. [Medline].

  13. Freedman MH. Recurrent' erythroblastopenia of childhood. An IgM-mediated RBC aplasia. Am J Dis Child. 1983 May. 137(5):458-60. [Medline].

  14. Gussetis ES, Peristeri J, Kitra V, et al. Clinical value of bone marrow cultures in childhood pure red cell aplasia. J Pediatr Hematol Oncol. 1998 Mar-Apr. 20(2):120-4. [Medline].

  15. Gustavsson P, Klar J, Matsson H, et al. Familial transient erythroblastopenia of childhood is associated with thechromosome 19q13.2 region but not caused by mutations in coding sequencesof the ribosomal protein S19 (RPS19) gene. Br J Haematol. 2002 Oct. 119(1):261-4. [Medline].

  16. Krijanovski OI, Sieff CA. Diamond-Blackfan anemia. Hematol Oncol Clin North Am. 1997 Dec. 11(6):1061-77. [Medline].

  17. Miller R, Berman B. Transient erythroblastopenia of childhood in infants < 6 months of age. Am J Pediatr Hematol Oncol. 1994 Aug. 16(3):246-8. [Medline].

  18. Mupanomunda OK, Alter BP. Transient erythroblastopenia of childhood (TEC) presenting as leukoerythroblastic anemia. J Pediatr Hematol Oncol. 1997 Mar-Apr. 19(2):165-7. [Medline].

  19. Tam DA, Rash FC. Breath-holding spells in a patient with transient erythroblastopenia of childhood. J Pediatr. 1997 Apr. 130(4):651-3. [Medline].

  20. Walters MC, Abelson HT. Interpretation of the complete blood count. Pediatr Clin North Am. 1996 Jun. 43(3):599-622. [Medline].

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