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Transient Erythroblastopenia of Childhood Workup

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

Laboratory Studies

The following studies are indicated in patients with suspected transient erythroblastopenia of childhood (TEC):

  • CBC count
    • CBC count results demonstrate a normochromic normocytic anemia, with a red cell morphology within the reference range on the peripheral smear.
    • Mean corpuscular volume (MCV) is usually within the reference range; however, MCV may be elevated if the patient has begun to recover and has reticulocytosis.
  • Hemoglobin studies
    • The hemoglobin level is usually 5-7 g/dL but may be as low as 2 g/dL.
    • Transient erythroblastopenia of childhood is frequently accompanied by clinically insignificant neutropenia that spontaneously resolves with the onset of reticulocytosis. Some series report the incidence of associated neutropenia to be as much as 64%.
    • In contrast, Diamond-Blackfan anemia is characterized by fetal-like hematopoiesis with an increased fetal hemoglobin, I antigen, and MCV.
  • Viral studies: A search for a viral etiology, such as cytomegalovirus, Epstein-Barr virus, and parvoviral immunoglobulin (Ig)G and immunoglobulin M, may be useful.
  • Reticulocyte count: Initial reticulocyte count is less than 0.1%, and a spontaneous increase heralds the recovery phase.
  • Iron studies: Iron studies are not indicated unless microcytosis is present. Serum iron levels may be elevated because of underuse.
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Imaging Studies

See the list below:

  • In individuals with suspected Diamond-Blackfan anemia, imaging studies may be helpful in revealing occult malformations; however, they are unnecessary for the diagnosis or treatment of transient erythroblastopenia of childhood.
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Other Tests

See the list below:

  • Bone marrow aspiration
    • Consider bone marrow studies when clinical history, physical findings, or CBC count is inconsistent with classic transient erythroblastopenia of childhood.
    • In patients with transient erythroblastopenia of childhood, findings include decreased or absent RBC precursors.
    • Evidence of marrow recovery precedes a rapid rise in hemoglobin levels; thus, bone marrow studies may help determine if a patient with transient erythroblastopenia of childhood who is severely anemic is likely to recover before requiring a blood transfusion.
    • In vitro studies have suggested that bone marrow cultures may have a future role in determining potential responsiveness of RBC aplasia to immunosuppressive therapy. In patients with classic presentations of transient erythroblastopenia of childhood, bone marrow cultures and immunosuppressive agents do not currently play a role.
  • Enzyme levels: Red cell adenosine deaminase levels have been used to differentiate Diamond-Blackfan anemia from transient erythroblastopenia of childhood and other anemias. Enzyme levels are typically elevated in Diamond-Blackfan anemia, whereas levels found in persons with transient erythroblastopenia of childhood are normal or depressed.
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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
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  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].

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  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].

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