Pure Red Cell Aplasia with Overlapping Hemolytic Anemia in a Term Neonate: A Case Report

Abstract Pure Red Cell Aplasia (PRCA) is an infrequent hematological disorder marked by profound inhibition of erythroid production with preservation of other marrow cell lines. Its occurrence during the neonatal period is rare and often leads to delayed recognition. We describe a term neonate who presented with progressive pallor and severe anemia during the second week of life. Hematological evaluation revealed persistent normocytic normochromic anemia with marked reticulocytopenia. Bone marrow examination demonstrated selective erythroid hypoplasia with intact myeloid and megakaryocytic maturation, along with erythroblasts containing intranuclear inclusions, pointing toward Parvovirus B19–associated PRCA. Laboratory parameters also suggested a mild concomitant hemolytic process. The infant required repeated packed red blood cell transfusions and showed gradual hematologic recovery following intravenous immunoglobulin administration. This report emphasizes the need for heightened clinical suspicion of viral-induced PRCA in neonates presenting with unexplained severe anemia and highlights the benefit of early diagnostic evaluation and targeted therapy.