The Hematologic Response

  • Donald H. MahoneyJr.
  • Donald J. Fernbach
Part of the Clinical Topics in Infectious Disease book series (CLIN.TOP.INFECT)


Patients with the Epstein-Barr virus (EBV) infection may present with a variety of clinical manifestations and complications. In particular, a wide range of hematologic complications, including anemia, neutropenia, and thrombocytopenia, may accompany the classic clinical syndrome of infectious mononucleosis (IM) or may occur in the otherwise asymptomatic infection. In the latter possibility, isolated hematologic disturbances resulting from EBV infection can only be identified by serologic methods. Fortunately, the majority of hematologic complications of the IM syndrome are self-limited and contribute little to the overall morbidity of this disease.


Aplastic Anemia Infectious Mononucleosis Autoimmune Hemolytic Anemia Hematologic Response Hereditary Spherocytosis 
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  1. Baehner, R.L., (1978). Lymphocytes. In Smith’s Blood Diseases of Infancy and Childhood D.R. Miller, H.A. Pearson, R.L. Baehner, and C.W. McMillan (eds). St. Louis, C.V. Mosby Company, pp. 557–587.Google Scholar
  2. Bowman, H.S., Marsh, W.L., Schumacher, H.R., Oyen, R., and Reihart, J. (1974). Auto-anti-N im- munohemolytic anemia in infectious mononucleosis. Am. J. Clin. Pathol. 61:465–472.PubMedGoogle Scholar
  3. Broughton, C.R., Marsh, W.L., Schumacher, H.R., Oyen, R., and Reihart, J. (1974). Glandular fever: A study of a hospital series in Sydney. Med, J. AusL 57:529–535.Google Scholar
  4. Burkart, P.T., and Hsu, T.C. (1979). IgM cold-warm hemolysis in infectious mononucleosis. Transfusion 19:535–538.PubMedCrossRefGoogle Scholar
  5. Cantow, F.F., and Kostinas, J.E. (1966). Studies on infectious mononucleosis. IV. Changes in the granulocyte series. Am. J. Clin. Pathol. 46:43–47.PubMedGoogle Scholar
  6. Capra, J.D., Dowling, P., Cook, S., and Kunkel, H.G. (1969). An incomplete cold reacting G antibody with i specificity in infectious mononucleosis. Vox Sang 16:10–17.PubMedCrossRefGoogle Scholar
  7. Carter, R.L. (1969). Granulocyte in infectious mononucleosis. InInfectious Mononucleosis Oxford, R.L. Carter and H.G. Penman, (eds.). Blackwell Scientific Publications, pp. 111 -120.Google Scholar
  8. Casey, T.P., and Matthews, J.R.D. (1973). Thrombocytopenic purpura in infectious mononucleosis. N.Z. Med. J. 77:318–320.PubMedGoogle Scholar
  9. Chambers, C.V., and Irwin, G.E. (1986). Intense jaundice in an adolescent. An unusual presentation of infectious mononucleosis. J. Adol. Health Care 7:195–197.CrossRefGoogle Scholar
  10. Chang, R.S. (1980). Infectious Mononucleosis Boston, G.K. Hall Medical Publishers.Google Scholar
  11. Cooper, E.H. (1969). Experimental studies of the atypical mononuclear cell. In Infectious Mononucleosis R.L. Carter and H.G. Penman (eds.). Oxford, Blackwell Scientific Publications.Google Scholar
  12. Dharmkrong-At, A., and Blood, G.E. (1973). Acquired hemolytic anemia associated with infectious mononucleosis in a patient with congenital pyruvate kinase deficiency. Clin. Ped. (Phila.) 12:119–121.CrossRefGoogle Scholar
  13. Dorman, J.M., Glich, T.H., Shannon, D.G., Galda- bin, J., and Walker, A. (1974). Complications of infectious mononucleosis. A fatal case in a 2-year- old child.Am. J. Dis. Child 128:239–243.PubMedGoogle Scholar
  14. Dodsworth, H., and Bums, A., (1971). Disseminated intravascular coagulation complicating infectious mononucleosis. Br. Med. J. 4:466–467.PubMedCrossRefGoogle Scholar
  15. Downey, H., and McKinlay, C.A. (1923). Acute lymphadenosis compared with acute lymphatic leukemia. I. Clinical study.Arch. Intern. Med. 32:82–112.CrossRefGoogle Scholar
  16. Dubois, D.R., and Baehner, R.L. (1979). Infectious mononucleosis associated with fatal beta hemolytic streptococcal infection. Clin. Ped. (Phila.) 18: 511–512.CrossRefGoogle Scholar
  17. Finch, S.C. (1969). Laboratory findings in infectious mononucleosis. In Infectious Mononucleosis R.L. Carter and H.G. Penman (eds.). Oxford, Blackwell Scientific Publications, pp. 47–52.Google Scholar
  18. Fingeroth, J.D., Weis, J.J., Tedder, T.F., Strominger, J.L., Biro, P.A., and Fearon, D.T. (1984). Epstein- Barr vims receptor of human B lymphocytes is the C3d receptor CR2. Proc. Natl. Acad Sei. (USA) 81:4510–4514.CrossRefGoogle Scholar
  19. Godal, H.C., and Skaga, E. (1969). Aggravation of congenital spherocytosis during infectious mononucleosis. Scand. J. Haematol 6:33–35.PubMedCrossRefGoogle Scholar
  20. Goldberg, L.S., and Bamett, E.C. (1967). Mixed G-M gold agglutinin. J. Immunol. 99:803–809.PubMedGoogle Scholar
  21. Grierson, H., and Purtilo, D.T. (1987). Epstein-Barr vims infections in males with XLP syndrome. Ann. Intern. Med 106:538–545.PubMedGoogle Scholar
  22. Grishaber, J.E., McClain, K.L., Mahoney, D.H. and Fembach, D.J. (1988). Successful outcome of severe aplastic anemia following Epstein-Barr vims infection. Am. J. Hematol. 28:273–275.PubMedCrossRefGoogle Scholar
  23. Gronemeyer, P., Chaplin, H., Chazarian, V., Tuscany, F., and Wilner, G.D. (1981). Hemolytic anemia complicating infectious mononucleosis due to the interaction of an IgG cold anti-i and an IgM cold rheumatoid factor. Transfusion 21: 715–718.PubMedCrossRefGoogle Scholar
  24. Habib, M.A., Babka, J.C., and Bumingham, R.A. (1973). Profound granulocytopenia associated with infectious mononucleosis. Am. J. Med. Sei 265:339–346.CrossRefGoogle Scholar
  25. Hammond, W.P., Harlan, J.M., and Steinberg, S.E. (1979). Severe neutropenia in infectious mononucleosis. West. J. Med 131:92–97.PubMedGoogle Scholar
  26. Herrod, H.G., Dow, L.W., and Sullivan, J.L. (1983). Persistent Epstein-Barr vims infection mimicking Juvenile chronic myelogenous leukemia: Immunologic and hematologic studies. Blood 61: 1098–1104.PubMedGoogle Scholar
  27. Hoaglund, R.J. (1967). Infectious Mononucleosis. New York and London, Gmne & Stratton.Google Scholar
  28. Horwitz, C.A. Heule, W., Heule, G., Goldfarb, M., Kubec, P., Gehrz, R.C., Balfour, H.H., Reisher, G.R., Krivit, W. (1981). Clinical and laboratory evaluation of infants and children with Epstein- Barr vims-induced infectious mononucleosis: Report of 32 patients (ages 10–48 months). Blood 57:933–938.PubMedGoogle Scholar
  29. Hossaini, A.A. (1970). Anti-i in infectious mononucleosis.Am. J. Clin. Pathol. 53:198–203.PubMedGoogle Scholar
  30. Ho-Yen, D.O. (1978). Auto-immune haemolytic anaemia complicating infectious mononucleosis in a patient with hereditary elliptocytosis.Acta Haemat. (Basel) 59:45–52.CrossRefGoogle Scholar
  31. Jenkins, W.J., Köster, G.H., Marsh, W.L., and Carter, R.L. (1965). Infectious mononucleosis: an unsuspected source of anti-i. Br. J. Haematol 11:480–483.PubMedCrossRefGoogle Scholar
  32. Kass, L. (1979). Bone Marrow Interpretation. Philadelphia, J.B. Lippincott.Google Scholar
  33. Katz, P., Zaytown, A., Lee, J.H., Jr., and Fauci, A.S. (1984). In vivo Epstein-Barr vims induced augmentation of natural killer cell activity in the Che- diah-Higashi syndrome.Immunol 132: 571–573.Google Scholar
  34. Kaziner, B., Hadler, N., Parilli, J., and Ellman, L. (1973). Agranulocytosis following infectious mononucleosis. JAMA 225:1235–1236.Google Scholar
  35. Lazarus, K.H., and Baehner, R.L. (1981). Aplastic anemia complicating infectious mononucleosis: A case report and review of the literature. Pediatrics 67:907–910.PubMedGoogle Scholar
  36. Lee, C.H., Hägen, M.A., Chong, B.H., Grace, C.S., and Rosenberg, M.C. (1980). The Lewis system and secretor status in autoimmune hemolytic anemia complicating infectious mononucleosis. Transfusion 20:585–588.PubMedCrossRefGoogle Scholar
  37. Limarzi, L.R., Paul, J.T., and Poncher, H.G. (1946). Blood and bone marrow in infectious mononucleosis. J. Lab. Clin. Med 31:1079–1100.PubMedGoogle Scholar
  38. Lusher, J.M., and Iyer, R. (1977). Idiopathic thrombocytopenic purpura in children. Semin. Thromb. Hemostas. 3:3.Google Scholar
  39. Mahoney, D.H., Fembach, D.J., Starke, J.R., and Reid, B.S. (1987). Profound hyperbilirubinemia: An unusual presentation of childhood infectious mononucleosis. Ped. Infect. Dis. 6:74–75.Google Scholar
  40. Mazza, J.J., and Magnin, O.E. (1975). Severe thrombocytopenia in infectious mononucleosis. Report of two cases and review of the literature. Wis. Med. J. 74:5124–5127.Google Scholar
  41. McKenna, R.W., Parkin, J., Gajl-Peczalska, K.J., Kersey, J.H., and Brunning, R.D. (1977). Ultra- structural, cytochemical, and membrane surface marker characteristics of the atypical lymphocytes in infectious mononucleosis. Blood 50:505- 515.PubMedGoogle Scholar
  42. Mroczek, E.L., Weisenburger, D.D., Grierson, H.L., Marlem, R., and Purtilo, D.T. (1987). Fatal infectious mononucleosis and virus associated hemo- phagocytic syndrome. Arch. Pathol. Lab. Med. 11:530–535.Google Scholar
  43. Neel, E.U. (1976). Infectious mononucleosis: Death due to agranulocytosis and pneumonia. JAMA 236:1493–1494.PubMedCrossRefGoogle Scholar
  44. Papamichail, M., Sheldon, P.J., and Holborow, E.J. (1974). T- and B-cell subpopulations in infectious mononucleosis. Clin. Exp. Immunol. 18:1–11.Google Scholar
  45. Pelletier, L.L., Borel, D.M., Romig, D.A., and Liu, C. (1976). Disseminated intravascular coagulation and hepatic necrosis. Complications of infectious mononucleosis. JAMA 235:1144–1146.PubMedCrossRefGoogle Scholar
  46. Penman, H.G. (1970). Fatal infectious mononucleosis: A critical review. J. Clin. Pathol 23:765- 771.Google Scholar
  47. Rädel, E.G., and Schorr, J.B. (1963). Thrombocytopenic purpura and infectious mononucleosis. J. Ped 63:46–60.CrossRefGoogle Scholar
  48. Rapp, C.E., and Hewetson J.R., (1978). Infectious mononucleosis and the Epstein-Barr virus. Am. J. Dis. Child 132:78–86.PubMedGoogle Scholar
  49. Rickinson, A.B. (1986). Cellular immunological responses to the virus infection. In Epstein-Barr Virus M.A. Epstein and B.G. Achong (eds.). New York, Wiley, p. 75.Google Scholar
  50. Risdale, R.J., McKenna, R.W., Nesbit, M.E., Krivit, W., Balfour, H.H., Simmons, R.L., and Brunning R.D. (1979). Virus-associated hemophagocytic syndrome. A benign histiocyte proliferation distinct from malignant histiocytosis. Cancer 44: 993–1002.CrossRefGoogle Scholar
  51. Robinson, J., Smith, D., and Niederman, J.A., (1980). Mitotic EBNA-positive lymphocytes in peripheral blood during infectious mononucleosis. Nature 287:334–335.PubMedCrossRefGoogle Scholar
  52. Rosdahl, N., and Svejgaard, a. (1979). HLA types and ABO blood groups in patients with infectious mononucleosis.Tissue Antigens 13:223–227.PubMedCrossRefGoogle Scholar
  53. Rothwell, D.J. (1975). Bone marrow granulomas and infectious mononucleosis. Arch. Pathol. 99: 508–509.PubMedGoogle Scholar
  54. Schooley, R.T., Densen, P., Harmon, D., Felsenstein, D., Hirsh, M.S., Henle, W., and Weitzman, S. (1984). Antineutrophil antibodies infectious mononucleosis. Am. J. Med. 76:85–90.PubMedGoogle Scholar
  55. Schumacher, H.R., McFeeley, A.E., and Maugel, T.K. (1969). The mononucleosis cell. III. Electron microscopy. 33:833–842.Google Scholar
  56. Seeley, J., Suedmyr, E., Weiland, O., Klein, G., Moller, E., Eriksson, E., Andersson, K., and Van der Wool L. (1981). Epstein-Barr virus—Selective T cells in infectious mononucleosis are not restricted to HLA-A and B antigens. J. Immunol. 127:293–301.PubMedGoogle Scholar
  57. Shadduck, R.K., Winkelstein, A., Zeigler, Z., Lichten, J., Goldstein, M., Michaels, M., and Rabin, B. (1979). Aplastic anemia following infectious mononucleosis: Possible immune etiology. Exp. Hema- tol. 7:264–271.Google Scholar
  58. Shashaty, G.S., and Atamer, M.A., (1974). Hemolytic uremic syndrome associated with infectious mononucleosis. Am. J. Dis. Child. 127:720–722.PubMedGoogle Scholar
  59. Socinski, M.A., Ershler, W.B., Tosato, G., and Blaese, R.M. (1984). Pure red cell aplasia associated with chronic Epstein-Barr virus infection: Evidence for T-cell mediated suppression of erythmoid colony forming unit.J. Lag. Clin. Med. 104:995- 1006.Google Scholar
  60. Stevens, D.L., Everett, E., Boxer, L.A., and Landefeld, R.A. 1979). Infectious mononucleosis with severe neutropenia and opsonic antineutrophil activity. South. Med J 72:519–521.PubMedCrossRefGoogle Scholar
  61. StoUmann, B., Fonatsch, C.H., and Havers, W. (1985). Persistent Epstein-Barr virus infection associated with monosomy 7 or chromosome 3 abnormality in childhood myeloproliferative disorders. Br. J Haemal 60:183–196.CrossRefGoogle Scholar
  62. Sullivan, J.L. (1987). Hematologic consequences of Epstein-Barr virus infection. Hem. One. Clin. N. Am. 1:397–417.Google Scholar
  63. Sumaya, C.V., and Ench, Y. (1985). Epstein-Barr virus infectious mononucleosis in children. I. Clinical and general laboratory findings. Pediatrics 75:1003–1010.PubMedGoogle Scholar
  64. Thomas, W.J., Yasaka, K., Strong, D.M., Woodruff, C.M., Stass, S.A., and Schumacher, H.R. (1980). Hand-mirror lymphocytes in infectious mononucleosis. Blood 55:925–930.PubMedGoogle Scholar
  65. Troxel, D.B., Innella, F., and Cohen, R.J. (1966). Infectious mononucleosis complicated by hemolytic anemia due to anti-i. Am. J. Clin. Pathol. 46:625–631.PubMedGoogle Scholar
  66. van Doomik, M.C., van ‘T Veer-Korthof, E.T., and Wierenga, H. (1978). Fatal aplastic anemia complicating infectious mononucleosis.Scand. J. Hae- mat. 20:52–56.Google Scholar
  67. Vogel, S.J., and Reinhard, E.H. (1979). Paroxysmal nocturnal hemoglobinuria associated with infectious mononucleosis. Blood 54:351–353.PubMedGoogle Scholar
  68. Wechsler, H.F., Rosenblum, A.H., and Sills, C.T. (1946). Infectious mononucleosis: Report of an epidemic in an army post. II. Ann. Intern. Med. 25:236–265.Google Scholar
  69. Wilkinson, L.S., Petz, L.D., and Garratty, G.N. (1973). Reappraisal of the role of anti-i in haemoly- tic anaemia in infectious mononucleosis. Br. J. Haemat. 25:236–265.CrossRefGoogle Scholar
  70. Wishart, M.M, and Davey, M.G., (1973). Infectious mononucleosis complicated by acute haemolytic anaemia with a positive Donald-Landsteiner reaction.J. Clin. Pathol. 26:332–334.PubMedCrossRefGoogle Scholar
  71. Wong, S., and Bennett, B.A. (1982). Natural history of severe thrombocytopenia in infectious mononucleosis. Postgrad Med J. 58:249–251PubMedCrossRefGoogle Scholar
  72. Woodruff, R.K., and McPherson, A.K. (1976). Severe haemolytic anaemia complicating infectious mononucleosis. Aust. N.Z. J. Med. 6:569–570.PubMedCrossRefGoogle Scholar
  73. Worledge, S.M., and Dacie, J.V. (1969). Haemolytic and other anaemias in infectious mononucleosis. In Infectious Mononucleosis R.L. Carter and H.G. Penman (eds.). Oxford, Blackwell Scientific Publications, pp. 83–98.Google Scholar
  74. Wulff, H.R. (1965). Acute agranulocytosis following infectious mononucleosis: Report of a case. Scand. J. Haemat. 2:179–182.PubMedCrossRefGoogle Scholar

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© Springer-Verlag New York Inc. 1989

Authors and Affiliations

  • Donald H. MahoneyJr.
  • Donald J. Fernbach

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