Document ID: FDA-2008-D-0379-0003
Agency: fda
Document Type: Supporting & Related Material
Title: 
Posted Date: 2008-07-30T04:00Z

<!DOCTYPE HTML PUBLIC "-//-//W3C//DTD HTML 3.2//EN">
<HTML>
<HEAD>
<META name="generator" content="Parvovirus B19: implications for transfusion medicine. Summary of a workshop">
<META name="creation-date" content="30/07/2008 03:24:33 ">
<TITLE>Parvovirus B19: implications for transfusion medicine. Summary of a workshop</TITLE>
<SCRIPT LANGUAGE="JavaScript1.2"> var agt=navigator.userAgent.toLowerCase();if ( (parseInt(navigator.appVersion)>=4) &&(agt.indexOf('mozilla')!=-1) && (agt.indexOf('spoofer')==-1)&& (agt.indexOf('compatible') == -1) ){msie = false;} else if ( (parseInt(navigator.appVersion)>=4) &&(agt.indexOf('msie') != -1) ) {msie = true;	} page=0;</SCRIPT>
</HEAD>
<BODY bgcolor="#ffffff" text="#000000" topmargin=0 leftmargin=0 marginheight=0 marginwidth=0 >
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:107.45pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">BROWN ET AL.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:817.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">130 </FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:83.35pt;top:817.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">TRANSFUSION</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:149.30pt;top:817.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Volume 41, January 2001</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:479.05pt;top:818.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt"><a href="http://www.transfusion.org">www.transfusion.org</a></FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:290.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 63.70pt">H</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:110.65pt;top:295.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">uman B19 parvovirus (B19), a pathogenic hu-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:110.65pt;top:307.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">man virus first identified in 1975,/is a common</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:239.05pt;top:306.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">1</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:110.65pt;top:319.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">contaminant of pooled plasma or plasma de-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:110.65pt;top:331.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">rivatives. Solvent/detergent-treated (SD) plas-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:343.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ma, factor VIII concentrates, and rarely, single-donor blood</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:355.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">components have induced B19 viremia in recipients.To</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:367.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">further explore the clinical implications of B19 in blood</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:379.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">components, the National Heart, Lung, and Blood Institute</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:391.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">(NHLBI) convened a workshop on December 16, 1999. The</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:403.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">workshop included presentations on the structure of B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:415.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">and the pathophysiology of B19 infections, as well as the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:427.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">epidemiology, immunology, and clinical manifestations of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:439.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the virus. Also discussed were the frequency of B19 viremia</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:451.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">in blood donors, potential clinical consequences of trans-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:463.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">fusion-associated B19 infection, and issues surrounding</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:475.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">screening of blood supply and individual donors for B19.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:487.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The conference concluded with a summaryof suggestions</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:499.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">for further basic and clinical research with respect to B19.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:511.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The full affiliations of the speakers and organizers are listed</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:523.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">at the end of this report.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:129.10pt;top:549.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">PARVOVIRUS B19</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:567.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 9.50pt">Structural and biochemical features</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:583.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">K</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:65.75pt;top:583.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">evin Brown, MD,and Neal Young, MD,began the meeting</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:595.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">with an overview of the structural and biochemical features</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:607.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">of B19, as well as the pathology, epidemiology, and clinical</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:619.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">manifestations of infection (a more comprehensive review</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:631.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">is presented in Anderson and Young).</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:205.45pt;top:630.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:295.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">B19 is a small nonenveloped virus with a single-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:307.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">stranded DNA genome (approx. 5500 nucleotides) with ter-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:319.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">minal hairpins./The virus is difficult to clone because of the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:378.50pt;top:318.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:331.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">long, 176-nucleotide hairpins at each end of the genome.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:343.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The small genome and the lack of membrane contribute to</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:355.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the heat and detergent resistance of the virus.Itis classi-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:367.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">fied as an erythrovirus because it is highly tropic for eryth-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:379.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">roid progenitor cells and because complete replication of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:391.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">B19 has been found only in these cells.Studies of viral in-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:403.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">fectivity have utilized erythroid progenitor cells derived</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:415.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">from bone marrow, peripheral blood, or fetal liver. Some</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:427.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">other cell lines allow for replication,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:458.90pt;top:426.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">4,5</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:468.30pt;top:427.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">but the process is not</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:439.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">efficient. Inproductive infection, two capsid proteins, the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:451.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">minor capsid protein VP1 and the major capsid protein VP2,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:463.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">are synthesized./The expression of VP2 alone or of VP1 and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:381.85pt;top:462.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">6</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:475.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">VP2 in combination leads to self-assembly of virus-like</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:487.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">particles./The infection of susceptible cells and the expres-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:354.95pt;top:486.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">7</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:499.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">sion of the nonstructural protein cause apoptosis,/prob-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:523.20pt;top:498.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">8</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:511.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ably through induction of the caspase cascade. Nonstruc-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:523.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tural protein production is cytotoxic, even in cells in which</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:535.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the viral capsid proteins are not produced./Thus, cell death</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:485.30pt;top:534.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">9</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:547.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">can occur even without virus replication.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:559.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The cellular receptor for B19 has been identified as</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:571.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">globoside,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:359.75pt;top:570.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">10</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:368.30pt;top:571.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">also known as blood group P antigen. Globo-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:583.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">side is also responsible for the phenomenon of B19 hemag-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:595.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">glutination, and the addition of globoside antibody or ex-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:607.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">cess globoside to bone marrow/cultures inhibits B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:619.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">infection. Furthermore,individuals who lack blood group</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:631.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">P antigen on their erythroid cells arenot susceptible to in-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:643.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">fection with B19.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:387.10pt;top:642.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">11</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:395.85pt;top:643.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Globoside is also found on cells in the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:655.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">bone marrow, especially erythroid precursors and mega-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:667.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">karyocytes, and on cells in the placenta and the fetal myo-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:679.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">cardium. Although fetal malformations due to B19 in preg-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:691.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">nancy have not been described (apart from one case</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:703.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">report/), fetal myocarditis almost certainly contributes to</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:343.20pt;top:702.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">12</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:715.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">B19-induced hydrops fetalis. Globoside is also expressed on</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:727.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">HPCs of the liver, as well as on cells in the kidney and thy-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:739.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">roid. The concentration of globoside on nonhematopoietic</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:751.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tissues does not appear sufficient for activeinfection, and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:763.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">other factors may be required for virus internalization and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:775.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">virus replication.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:105.60pt;top:170.80pt;z-index:3;"><FONT FACE ="Utopia-Semibold" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 16.00pt">Parvovirus B19: implications for transfusion medicine.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:216.25pt;top:192.85pt;z-index:3;"><FONT FACE ="Utopia-Semibold" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 16.00pt">Summary of a workshop</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:130.55pt;top:244.55pt;z-index:3;"><FONT FACE ="Utopia" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">Kevin E. Brown, Neal S. Young, Barbara M. Alving, and Luiz H. Barbosa</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:662.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">ABBREVIATIONS: </FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:131.30pt;top:664.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">B19 = human B19 p\rvovirCs; NHLBI = Na-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:676.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">tion\l He\rt, LCng, \nd Blood InstitCte; SCD = sickle cell dise\se;</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:688.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">SD =solvent/detergent-tre\ted; SPV = simian parvovirus.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:703.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">From the National Heart, Lung, and Blood Institute, National</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:715.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Institutes of Health, Bethesda, Maryland.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:727.95pt;z-index:3;"><FONT FACE ="Utopia" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Address reprint requests to: </FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:175.70pt;top:727.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Luiz H. Barbosa, DVM, NHLBI,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:739.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Rockledge II, Room 10146, 6701 Rockledge Drive, Bethesda, MD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:751.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">20892; e-mail: BarbosaL@NIH.gov.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:763.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Received for publication March 28, 2000; revision received</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:775.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">June 23, 2000, and accepted July 10, 2000.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:787.95pt;z-index:3;"><FONT FACE ="Utopia-Semibold" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">TRANSFUSIO</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:137.40pt;top:787.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2001;41:130-135.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:218.65pt;top:101.55pt;z-index:3;"><FONT FACE ="Modern735BT-RomanA" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 18.00pt">CONFERENCE   R E P O R T</FONT></FONT></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:0.00pt;z-index:-1;"><img style="width:720pt;height:864pt;" src="outputfile-613674016.htm_files\outputfile-613674016_background0.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:864.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:369.60pt;top:970.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">PARVOVIRUS B19 IN TRANSFUSION MEDICINE</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:375.10pt;top:1681.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Volume 41, January 2001 </FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:1681.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">TRANSFUSION </FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:527.80pt;top:1681.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">131</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1681.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt"><a href="http://www.transfusion.org">www.transfusion.org</a></FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1007.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 9.50pt">Epidemiology and experimental infection</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1023.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The seroconversion rate has been calculated as about 1.5</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1035.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">percent per year for women of childbearing age./ Around</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:254.90pt;top:1034.55pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">13</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1047.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the world, the seroprevalence is about 50 percent in adults,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1059.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">in part because of the infection of adult family members by</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1071.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">school-age children. There is seasonal variation in infec-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1083.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tion, and the major mode of transmission is thought to be</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1095.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">respiratory.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:1107.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Inone study in the United Kingdom of the time course</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1119.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">of infection, virus was administered intranasally to healthy</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1131.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">adult volunteers.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:128.15pt;top:1130.55pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:136.50pt;top:1131.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Six days later, a peak in viremia was de-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1143.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tected, which correlated with fever, chills, headache, and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1155.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">myalgia (Fig. 1). This was followed byan antibody response,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1167.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">with IgM anti-B19 appearing around the 10th day. IgG anti-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1179.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">B19 was detected a few days later;this was concurrent with</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1191.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the appearance of the classic B19 rash, which was mani-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1203.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">fested on the face as slapped-cheek rash and on the ex-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1215.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tremities as a lacy reticular pattern. Reticulocytopenia with-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1227.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">out anemia occurred even in the healthy volunteers.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1249.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 9.50pt">Clinical manifestations of infection</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1265.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The clinical manifestations of B19 infection range from</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1277.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">chills, headache, and rash in children to fetal hydrops in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1289.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">pregnant women infected in the first half of pregnancy.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:287.75pt;top:1288.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">15</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1301.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Because B19 is tropic for erythroid progenitor cells, indi-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1313.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">viduals who have a shortened RBC survival time, such as</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1325.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">those with sickle cell disease (SCD) and other hemolytic</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1337.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">anemias, are at risk for B19-induced anemia due to RBC</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1349.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">aplasia. Individuals who are immunosuppressed are also at</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1361.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">risk for severe chronic anemia. Many of these patients re-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1373.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">spond well to IVIG.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:137.30pt;top:1372.50pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">16</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:1385.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Inchildren, B19 may initially cause chills, headache,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1397.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">myalgia, and gastrointestinal disturbance, and then a</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1009.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">slapped-cheek rash, but usually patients feel remarkably</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1021.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">w</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:324.95pt;top:1021.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ell./One to 2 days later, a rash develops on arms and legs.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.70pt;top:1020.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">17</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1033.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The cutaneous eruption is generally not apparent in older</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1045.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">patients infected with B19, but in adults, especially women,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1057.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">up to 50 percent complain of arthropathy, usually in a sym-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1069.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">metrical and peripheral distribution. Studies have at-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1081.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tempted to determine if B19 infection is associated with</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1093.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">rheumatoid arthritis, but most have not shown a link. In one</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1105.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">series, B19 DNA was found in the synovial tissue of 28 per-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1117.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">cent of the patients, but the virus was also found in the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1129.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">synovium of half of normal adults.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:456.50pt;top:1128.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">18</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:1141.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">M</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:344.40pt;top:1141.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">aternal B19 infection during the first half of preg-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1153.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">nancy can result in a hydropic fetus./If a woman is infected</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:458.65pt;top:1152.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1165.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">during Weeks 9 to 20 of pregnancy, there is about a10-per-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1177.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">cent incidence of fetal loss.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:427.90pt;top:1176.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">20</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:436.55pt;top:1177.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">If infection occurs later than</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1189.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Week 20, fetal loss is rare.B19 infection of fetal cardiac tis-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1201.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">sue may lead to myocarditis and heart failure, which con-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1213.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tribute to the development of hydrops. There may also be</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1225.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">cases of neurologic fetal abnormalities associated with in-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1237.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">trauterine infection.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:398.15pt;top:1236.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">21,22</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:413.55pt;top:1237.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">In addition, three cases of congeni-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1249.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tal anemia following confirmed B19 in pregnancy have been</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1261.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">described.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:360.95pt;top:1260.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">23</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:369.80pt;top:1261.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">A</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:375.55pt;top:1261.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ll the fetuses developed hydrops, two were</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1273.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">treated with intrauterine transfusion, and one was delivered</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1285.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">prematurely and treated with IVIG. In all, B19 DNA was</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1297.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">detected in the bone marrow byPCR. However, treatment</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1309.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">with immunoglobulin did not lead to symptomatic im-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1321.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">provement.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:1333.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The first disease associated with B19 infection was</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1345.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">transient aplastic crisis, which occurred in children with</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1357.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">SCD who wereimmigrants from the Caribbean living in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1369.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">London.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:352.30pt;top:1368.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">24</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:360.55pt;top:1369.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Further confirmation of the role of B19 in aplas-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1381.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tic crisis c\;e fro; \ stCdy in Clevel\nd of \n oCtbreak of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1393.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">aplastic crisis in persons with SCD at the time of aconcur-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1405.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">rent epidemic of fifth disease in otherwise healthy chil-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1417.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">dren.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:339.35pt;top:1416.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">25</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:1429.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Chronic severe anemia can be due to persistent B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1441.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">infection./The first patient recognized to have this condi-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:356.90pt;top:1440.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">26</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1453.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tion had an underlying combined B- and T-cell immuno-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1465.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">deficiency with low immunoglobulin levels (Nezlof’s syn-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1477.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">drome). The patient’s/blood contained B19 DNA at a</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1489.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">concentration of 10/genome copies per mL, as measured</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:397.45pt;top:1488.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">6</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1501.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">bydot-blot hybridization. This high viral titer continued to</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1513.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">occur over months. Inaddition, the patient experienced</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1525.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">iron overload due to frequent transfusions. After the patient</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1537.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">received a 10-day course of commercial IVIG, the viral ti-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1549.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ters fell and a marked reticulocytosis occurred. Intermittent</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1561.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">infusions of IVIG over the next few months led to the reso-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1573.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">lution of the parvovirCs infection \nd the RBC \pl\si\.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:1585.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">P</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:341.05pt;top:1585.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">atients with HIV infection can present with pure RBC</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1597.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">aplasia due to B19 infection; in these persons, B19 titers can</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1609.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">be as high as 10/genome copies per mL./The anemia can</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:379.20pt;top:1608.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">12</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:480.50pt;top:1608.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">16</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1621.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">be resolved if the patients receive IVIG treatments, which</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1633.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">may need to be given repeatedly because of recurrence of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1645.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the parvovirus infection.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1627.95pt;z-index:3;"><FONT FACE ="Utopia" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Fig.1. Clinical, hematologic, and viral course after B19 infec-</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:80.75pt;top:1628.10pt;z-index:3;"><FONT FACE ="Utopia" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">  </FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:80.75pt;top:1627.85pt;z-index:3;"><FONT FACE ="Utopia" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">  </FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1639.95pt;z-index:3;"><FONT FACE ="Utopia" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">tion in immunocompetent individuals (data modified from</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1651.95pt;z-index:3;"><FONT FACE ="Utopia" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Anderson et al. ).</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:116.15pt;top:1651.45pt;z-index:3;"><FONT FACE ="Utopia" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 5.20pt">14</FONT></FONT></b></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:864.00pt;z-index:-1;"><img style="width:720pt;height:864pt;" src="outputfile-613674016.htm_files\outputfile-613674016_background1.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:1728.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1835.45pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">BROWN ET AL.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2545.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">132 </FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:81.75pt;top:2545.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">TRANSFUSION</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:149.30pt;top:2545.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Volume 41, January 2001</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:479.05pt;top:2546.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt"><a href="http://www.transfusion.org">www.transfusion.org</a></FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1871.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 9.50pt">Pathogenesis</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1887.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">As </FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:71.90pt;top:1887.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">shown in experimental infection of volunteers, B19 in-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1899.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">fection has two phases.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:155.50pt;top:1898.55pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:163.90pt;top:1899.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The first is associated with vire-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1911.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">mia that results in bone marrowsuppression because of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1923.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">direct cytotoxicity to erythroid precursors. In patients with</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1935.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">shortened RBC survival, such as those with hemolytic ane-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1947.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">mias or SCD, the consequences may be catastrophic. The</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1959.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">second phase starts when the infection is terminated bythe</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1971.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">production of specific antibodies. Aresponse by T-lympho-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1983.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">cytes has not been well established, but the humoral re-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:1995.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">sponse is easily measured. This humoral response leads to</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2007.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the second part of the illness, fifth disease, which is almost</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2019.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">certainly immune complex-mediated and due to the depo-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2031.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">sition of immune complexes in skin, joints, and other or-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2043.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">gans, which causes the specific syndromes.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:2055.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Individuals at risk for prolonged B19 infection are those</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2067.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">who do not develop neutralizing antibodies to VP1, as mea-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2079.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">sured in erythroid progenitor assays.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:209.50pt;top:2078.55pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">27</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:218.05pt;top:2079.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">P</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:222.95pt;top:2079.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">atients with AIDS</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2091.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">usually have no anti-B19 at all, as they have the most severe</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2103.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">formof immunodeficiency. Inother patients, there may be</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2115.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">VP2 binding but an absence of anti-VP1. Co;;ercial IVIG</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2127.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">from avariety of sources have high titers of antibody against</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2139.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">VP1 and VP2, as determined byimmunoblot. These prod-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2151.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ucts can neutralize the virus and lead to its clearance from</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2163.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the blood and the bone marrow,allowing marrow erythro-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2175.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">poiesis to recover.One of the unanswered questions in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2187.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">parvovirus pathophysiology is whether the virus persists in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2199.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">a form that allows the activation of latent infection and if</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2211.60pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">so, in which cells.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:71.50pt;top:2238.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">IMMUNOLOGY OF B19 AND POTENTIAL</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:133.70pt;top:2251.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">FOR A VACCINE</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2271.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The virus has only two capsid proteins, the major capsid</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2283.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">protein VP2, which makes up most of the capsid protein,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2295.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">and a second protein, VP1, which makes up 5 percent or less</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2307.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">of the total capsid structure.VP1 is identical to VP2, except</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2319.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">that it has an additional 226 amino acids at the aminoter-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2331.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">;in\l; this unique region is crucial for an adequate immune</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2343.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">response.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:98.90pt;top:2342.55pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">28</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:2355.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Capsid formation can occur with VP2 expressed recom-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2367.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">binantly in the baculovirus syste;; VP1 is not an absolute</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2379.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">requirement for capsid formation./These baculovirus-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:206.65pt;top:2378.55pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">7</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2391.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">derived B19 antigens have been used to develop IgG and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2403.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">IgM assays, eliminating the requirement for the natural vi-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2415.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">rus,which is difficult to obtain. Crystallization studies of the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2427.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">empty capsids have been successfully done in collaboration</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2439.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">with Rossmann at Purdue University (West Layfayette, IN)</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2451.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">and have shown that B19 is structurally quite distinct from</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2463.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">canine parvovirus./These studies have been useful in de-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:135.10pt;top:2462.55pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">29</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2475.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">termining binding sites for MoAbs, but they have not de-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2487.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">fined the unique VP1 region, which cannot be detected in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2499.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">structural studies.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:2511.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Preclinical in vivo/experiments suggest that VP1 is</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2523.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">needed to induce an effective immune response: capsids</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1873.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">composed of VP2 alone are not sufficient to do so. A B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1885.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">vaccine antigen has been produced byengineering capsids</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1897.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">that were structurally sound and that contain 20 to 40 per-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1909.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">cent VP1 instead of the 5 percent or less usually found in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1921.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the B19 virion. These VP1-enhanced capsids should be use-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1933.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ful, with an appropriate adjuvant, as a vaccine to protect</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1945.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">susceptible children and women of gestational age. A VP1-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1957.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">enhanced vaccine is in commercial development, and ex-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1969.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">periments are being conducted in normal volunteers with</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1981.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">an adjuvant that should stimulate the production of high</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:1993.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">titers of neutralizing antibodies without toxicity. Inaddi-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2005.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tion, an RT-PCR assay utilizing the semipermissivecell line</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2017.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">UT7/Epo to measure the neutralization response to the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2028.25pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">vaccine has been developed.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:434.40pt;top:2027.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">30</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:357.85pt;top:2053.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">AN ANIMAL MODEL FOR B19</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2072.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">An animal model for B19 infection has been developed by</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2084.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">using a parvovirus originally isolated from anemic cyno-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2096.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">molgus monkeys.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:389.75pt;top:2095.60pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">31</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:398.15pt;top:2096.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The virus,simian parvovirus (SPV), is</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2108.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">very similar at the genomic level to parvovirus B19. Cyno-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2120.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">molgus monkeys, when inoculated with this virus, have</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2132.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">transient high titers of virus and reticulocytopenia, which</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2144.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">are followed by the development of an antibody response.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2156.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Inimmunosuppressed monkeys, life-threatening anemia</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2168.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">can occur with prolonged viremia. When monkeys are in-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2180.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">oculated in the first half of pregnancy, hydrops also occurs</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2191.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">in their fetuses.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:380.40pt;top:2190.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">32</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:365.30pt;top:2216.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">TESTING AND DIAGNOSIS</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2235.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Bernard Cohen, PhD, and Larry Anderson, MD,gave an</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2247.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">update of current methods for diagnosing B19 infection and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2259.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">pointed out that diagnostic methods for B19 infection are</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2271.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">usually determined bythe clinical perspective (for a review,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2283.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">see Erdman/). IgM antibodies have been the core of B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:366.50pt;top:2282.55pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">33</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2295.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">diagnosis for acute infection, while the appearance of IgG</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2307.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">antibodies is indicative of past infection, either resolved or</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2319.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">chronic.The virus can be visualized byelectron microscopy.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2331.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Histopathologic findings suggestive of B19, such as giant</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2343.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">pronormoblast formation, and antigen detection or DNA</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2355.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">detection byin situ hybridization are also diagnostic tools.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:2367.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">M</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:344.40pt;top:2367.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">orerecently, B19 NAT has been used to detect the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2379.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">virus in acute disease. Insome instances, lowlevels of B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2391.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">DNA persist in the serum in the presence of antibody with-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2403.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">out any clear link to transmissibility or evidence of disease.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2415.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The induction of effective neutralizing antibody depends</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2427.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">upon a strong response to VP1, but in ELISAs, there is no</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2439.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">appreciable difference in the sensitivity of the assay when</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2451.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">VP1 rather than VP2 antigens are used. The use of whole-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2463.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">virus antigen in ELISA appears to increase sensitivity in the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2475.40pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">detection of IgM antibodies, but it does not influence the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2487.35pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">sensitivity of detection of IgG. The ELISA format is impor-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2499.35pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tant, particularly for the IgM assay; the capture antibody</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2511.35pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">format increases both the sensitivity and specificity for IgM,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2523.35pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">whereas an indirect assay is better for IgG.</FONT></FONT></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:1728.00pt;z-index:-1;"><img style="width:720pt;height:864pt;" src="outputfile-613674016.htm_files\outputfile-613674016_background2.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:2592.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:369.60pt;top:2698.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">PARVOVIRUS B19 IN TRANSFUSION MEDICINE</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:375.10pt;top:3409.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Volume 41, January 2001 </FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:3409.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">TRANSFUSION </FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:527.80pt;top:3409.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">133</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3409.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt"><a href="http://www.transfusion.org">www.transfusion.org</a></FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:84.00pt;top:2733.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">B19 AND TRANSFUSION MEDICINE</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2753.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Testing with several methods indicates that parvovirus is</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2765.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">present in the blood of 1in 20,000 to 1in 50,000 donors.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2777.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">During epidemic periods, the incidence can increase to as</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2789.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">high as 1 in 260 donors. Naomi Luban, MD, and Roger</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2801.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Dodd, PhD, pointed out that plasma pools usually contain</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2813.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">B19 as detected byDNA \n\lysis; the components derived</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2825.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">from them are usually administered to potentially vulner-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2837.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">able recipients, such as males with hemophilia who are al-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2849.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ready infected with HIV. The medical literature has several</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2861.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">reports of B19 transmission by these components.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:264.95pt;top:2860.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">34</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:273.70pt;top:2861.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Con-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2873.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">versely,only three transmissions due to single-donor com-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2885.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ponents have been described.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:181.70pt;top:2884.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">35-37</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:2897.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Joan Pehta, MD,presented a summary of the recent</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2909.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">postmarketing studies of SD plasma prepared byVITEX</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2921.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">(Melville, NY). The SD plasma contains antibodies to B19,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2933.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">and all plasma pools contain B19 DNA. Of 19 normal recipi-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2945.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ents of lots of SD plasma that contained high titers of B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2957.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">DNA (10/-10</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:94.55pt;top:2956.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">7.5</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:115.45pt;top:2956.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">8.5</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:125.25pt;top:2957.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">genome copies/mL), 7seroconverted at 7</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2969.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">to 10 days.Bythe end of 3months, 18 of the 19 recipients</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2981.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">had seroconverted and 14 of the 18 showed evidence of vi-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:2993.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">rus replication (increased level of viremia byPCR). The pres-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3005.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ence of anti-B19 in the plasma pools therefore was not pro-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3017.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tectiveagainst the large virus load. It is interesting that 58</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3029.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">recipients of lots with virus titers between 10</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:247.20pt;top:3028.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">0.5</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:258.00pt;top:3029.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">and 10</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:286.10pt;top:3028.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">3.5</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3041.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">genome copies per mL remained seronegative and had</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3053.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">negative tests for B19 DNA.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:3065.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Dodd and Cohen addressed the best methods to screen</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3077.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">for B19 in donor plasma, with the latter suggesting that</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3089.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">perhaps the receptor-mediated hemagglutination test de-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3101.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">veloped in Japan could be considered for screening blood</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3113.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">donors. This assay is simple and economic and has shown</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3125.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">quite promising results in astudy of over 250,000 subjects.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:287.75pt;top:3124.50pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">38</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3137.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">DNA studies usually are used to detect the presence of the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3149.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">virus,with the assumption that the presence of B19 DNA</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3161.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">correlates with infectious virus particles. Sensitive detec-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3173.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tion systems are capable of revealing low levels of B19 DNA,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3185.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">but it is difficult to interpret these results from aclinical</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3197.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">perspective.Current nucleic acid assays for B19 havea</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3209.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">range of sensitivity that varies by10,000-fold; therefore, if</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3221.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">blood units are to be screened, the level of sensitivity would</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3233.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">have to be established for determining the infectivity of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3245.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">PCR-positive specimens.The data derived from studies of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3257.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">SD plasma suggest that a B19 concentration of at least 10</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:286.10pt;top:3256.50pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">3.5</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3268.80pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">genome copies per mL is necessary to transmit viremia.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:108.25pt;top:3294.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">THE FDA’S PERSPECTIVE</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3313.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Thomas Lynch, JD,PhD, discussed the FDA’sposition re-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3325.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">garding NAT of plasma for further manufacture.The con-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3337.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">servative approach taken by the FDA in regard to NAT for</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3349.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">transfusion-associated viruses such as HIV and HCV can-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3361.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">not be applied to B19, and the FDA does not currently man-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3373.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">date screening for B19. The disease is of short duration and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2737.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">has a mild clinical coCrse; persistence of the virus andchronic</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2749.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">infections are extremely rare, except in immunocomprom-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2761.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ised patients. In addition, the illness does not have a win-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2773.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">dow period, because the acute phase is veryshort.Thus, the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2785.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">posture adopted bythe FDA is to use its licensing author-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2797.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ity to control the testing as an analytical tool. Manufactur-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2809.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ers of plasma products would be required to validate the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2821.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">B19 NAT in terms of specificity, sensitivity, and reproduc-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2833.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ibility.However, because the aim of the testing is to reduce</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2845.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the potential infectivity of the manufacturing pool, the FDA</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2857.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">does not requirethe manufacturer to show a correlation of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2869.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">test results with any particular clinical outcome. Onthe</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2881.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">basis of the VITEX experience, the FDA is currently propos-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2893.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ing that a manufacturer’sscreening process, regardless of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2905.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">its inherent sensitivity, should be capable of achieving</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2917.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">manufacturing pools that have plasma B19 DNA levels con-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2929.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">sistently below10/genome copies per mL. There is no need</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:388.30pt;top:2928.65pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">4</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2941.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">to identify individual positive units or the individual do-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2953.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">nors.During the validation of the test, however, it is impor-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2965.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tant to actually identify the individual positive unit to con-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2977.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">firm the positive result. The FDA proposes that any</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:2989.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">candidate B19 NAT be evaluated in 20 known-positive do-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3001.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">nations with a determination of the titer of each. Further-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3013.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">more, several minipools would be tested (yielding a total of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3025.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">100,000 donations). Positive results would be traced to the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3037.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">individual positive unit, and the titer would be determined.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:348.25pt;top:3065.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">UNRESOLVED CLINICAL ISSUES</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3085.45pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Our understanding of the role of B19 in SCD is still incom-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3097.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">plete.The NHLBI is sponsoring a seroprevalence study in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3109.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">patients with SCD to examine seroconversion rates for B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3121.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">and to determine the correlation of infection with illnesses,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3133.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">not only transient aplastic crisis, but also acute chest syn-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3145.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">dro;e \nd other co;plic\tions of SCD.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3157.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">B19 DNA can be detected in many organs bysensitive</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3169.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">assays such as PCR, but it is not known if the B19 in tissues</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3181.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">of an asymptomatic person can be reactivated, especially</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3193.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">if the person becomes immunosuppressed. The role of B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3205.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">in diseases such as hepatitis, myocarditis, and rheumatoid</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3217.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">arthritis is still unclear. For example,most of the studies do</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3229.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">not address whether the DNA found byPCR is full-length</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3241.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">or is capable of RNA transcription and cell infection.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3253.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">The prevalence of B19 and its role in anemia have not</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3265.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">been determined in many at-risk patient populations, such</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3277.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">as those with chronic lymphocytic leukemia or childhood</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3289.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">leukemias.One of the few systematic studies that has been</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3301.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">performed involved patients with HIV and AIDS.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3313.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Recently,B19 variants have been described/; these</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:517.90pt;top:3312.90pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.90pt">39</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3325.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">variants may be missed if only PCR is used, depending on</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3337.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">the primers chosen for amplification. Studies using direct</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3349.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">hybridization assays and longer probes should be capable</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3361.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">of detecting strains with less than 10 percent sequence</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3373.70pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">variation.</FONT></FONT></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:2592.00pt;z-index:-1;"><img style="width:720pt;height:864pt;" src="outputfile-613674016.htm_files\outputfile-613674016_background3.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:3456.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3563.45pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">BROWN ET AL.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4273.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1k </FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:80.10pt;top:4273.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">TRANSFUSION</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:149.30pt;top:4273.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Volume 41, January 2001</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:479.05pt;top:4274.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt"><a href="http://www.transfusion.org">www.transfusion.org</a></FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:3601.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Simian systems such as the cynomolgus monkey could</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3613.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">provide a good animal model in which to study RBC apla-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3625.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">sia and congenital anomalies as a correlate to the human</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3637.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">disease. The number of animals required is quite large, and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3649.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">such studies would be rather expensive.Nevertheless, if</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3661.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">human parvovirus B19 were perceived to be a serious pub-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3673.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">lic health threat, these studies could be considered.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:3685.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Because the current solvent/detergent method of in-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3697.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">activating viruses in blood products is ineffective against</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3709.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">parvovirus B19, other decontamination treatments should</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3721.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">be explored.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:148.55pt;top:3747.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">SUMMARY</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3767.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">This 1-day workshop showed that the infectivity of B19 DNA</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3779.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">in donor blood and the neutralizing action of different an-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3791.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">tibodies present in the donated blood are not yet fully un-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3803.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">derstood. It/is possible that B19-induced anemia and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3815.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">reticulocytopenia are not being recognized in transfused</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3827.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">recipients other than those in specific risk groups. The test-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3839.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ing of blood components for any infectious agent is usually</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3851.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">clinically driven, and, if B19 NAT wererecommended at the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3863.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">present time in other than plasma products, a CMV-like</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3875.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">model might prove appropri\te; that is, virus screening</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3887.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">would be performed on blood components destined for</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3899.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">high-risk groups only.CCrrently, there is insufficient evi-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3911.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">dence to recommend universal testing, especially for single</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3923.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">units.Workshop participants recommended that basic re-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3935.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">search continue in the scientific areas addressed. If clini-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3947.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">cal trials were to be developed, participants recommended</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3959.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">that they include special risk groups such as seronegative</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3971.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">pregnant women and children with malignancies who are</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:3983.30pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">receiving chemotherapy.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:139.70pt;top:4010.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 11.00pt">REFERENCES</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4030.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="ffffff"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.30pt;top:4030.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4030.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Coss\rt YE, Field AM, C\nt B, Widdows D. Parvovirus-like</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4042.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">particles in human sera. Lancet 1975;1:72-3.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4054.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="ffffff"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.30pt;top:4054.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:68.70pt;top:4054.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4054.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Anderson LJ, Young NS, eds. Monographs in virology: hu-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4066.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">man parvovirus B19. Basel: Karger, 1997.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4078.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="ffffff"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.30pt;top:4078.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:68.70pt;top:4078.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4078.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Cot;ore SF, Tattersall P. Ch\r\cteriz\tion and molecular</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4090.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">cloning of a human parvovirus genome. Science</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4102.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1984;226:1161-5.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4114.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="ffffff"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.30pt;top:4114.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">4</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:68.70pt;top:4114.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4114.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Shimomura S, Komatsu N, Frickhofen N, et al. First con-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4126.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">tinuous propagation of B19 parvovirus in a cell line. Blood</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4138.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1992;79:18-24.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4150.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="ffffff"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.30pt;top:4150.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">5.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4150.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Munshi NC, Zhou S, Woody MJ, et al. Successful replication</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4162.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">of parvovirus B19 in the human megakaryocytic leukemia</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4174.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">cell line MB-02. J Virol 1993;67:562-6.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4186.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="ffffff"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.30pt;top:4186.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">6.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4186.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Ozawa K, Young N. Ch\r\cteriz\tion of capsid and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4198.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">noncapsid proteins of B19 parvovirus propagated in hu-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4210.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">man erythroid bone marrow cell cultures. J Virol</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4222.15pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1987;61:2627-30.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3601.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="ffffff"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:322.30pt;top:3601.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">7.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3601.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Kajigaya S, Fujii H, Field A, et al. Self-assembled B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3613.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">parvovirus capsids, produced in a baculovirus system, are</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3625.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">antigenically and immunogenically similar to native viri-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3637.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">ons. Proc Natl Acad Sci U S A 1991;88:4646-50.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3649.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="ffffff"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:322.30pt;top:3649.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">8</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:326.70pt;top:3649.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3649.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Ozawa K, Ayub J, Kajigaya S, et al. The gene encoding the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3661.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">nonstructural protein of B19 (human) parvovirus may be</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3673.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">lethal in transfected cells. J Virol 1988;62:2884-9.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3685.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="ffffff"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:322.30pt;top:3685.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">9.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3685.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Liu JM, Green SW, Shimada T, Young NS. A block in full-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3697.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">length transcript maturation in cells nonpermissive for B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3709.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">parvovirus. JVirol 1992;66:4686-92.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3721.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">10.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3721.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Brown KE, Anderson SM, Young NS. Erythrocyte P antigen:</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3733.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">cellular receptor for B19 parvovirus. Science 1993;262:114-7.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3745.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">11.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3745.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Brown KE, Hibbs JR, Gallinella G, et al. Resistance to</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3757.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">parvovirus B19 infection due to lack of virus receptor</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3769.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">(erythrocyte P antigen). N Engl J Med 1994;330:1192-6.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3781.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">12.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3781.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Weiland HT, Vermey-Keers C, Salimans MM, et al.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3793.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Parvovirus B19 associated with fetal abnormality (letter).</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3805.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Lancet 1987;1:682-3.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3817.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">13.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3817.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Koch WC, Adler SP. Human parvovirus B19 infections in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3829.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">women of childbearing age and within families. Pediatr In-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3841.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">fect Dis J 1989;8:83-7.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3853.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">14.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3853.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Anderson MJ, Higgins PG, Davis LR, et al. Experimental</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3865.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">parvoviral infection in humans. J Infect Dis 1985;152:257-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3877.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">65.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3889.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">15.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3889.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Brown KE. Human parvovirus B19 epidemiology and clini-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3901.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">cal manifestations. In: Anderson LJ, Young NS, eds. Mono-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3913.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">graphs in virology: human parvovirus B19. Basel: Karger,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3925.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1997:42-60.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3937.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">16.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3937.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Frickhofen N, Abkowitz JL, Safford M, et al. Persistent B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3949.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">parvovirus infection in patients infected with human im-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3961.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">munodeficiency virus type 1 (HIV-1): a treatable cause of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3973.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">anemia in AIDS. Ann Intern Med 1990;113:926-33.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:3985.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">17.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3985.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Brown KE, Young NS. Human parvovirus B19 infections in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:3997.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">infants and children. Adv Pediatr Infect Dis 1997;13:101-26.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4009.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">18.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4009.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Soderlund M, von Essen R, Haapasaari J, et al. Persistence</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4021.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">of parvovirus B19 DNA in synovial membranes of young</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4033.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">patients with and without chronic arthropathy. Lancet</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4045.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1997;349:1063-5.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4057.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">19.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4057.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Brown KE. What threat is human parvovirus B19 to the fe-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4069.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">tus? A review. Br J Obstet Gynaecol 1989;96:764-7.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4081.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:322.35pt;top:4081.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:326.70pt;top:4081.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4081.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Miller E, Fairley CK, Cohen BJ, Seng C. Immediate and long</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4093.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">term outcome of human parvovirus B19 infection in preg-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4105.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">nancy. Br J Obstet Gynaecol 1998;105:174-8.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4117.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:322.35pt;top:4117.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4117.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Anlar B, Öktem F, Török T. Human parvovirus B19 antibod-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4129.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">ies in infantile autism. J Child Neurol 1994;9:104-5.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4141.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:322.35pt;top:4141.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:326.70pt;top:4141.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4141.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Török TJ, Andrews I, Conry JA, et al. Congenit\l central ner-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4153.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">vous system disease following intrauterine parvovirus B19</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4165.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">infection (abstract). Presented at the 5th Parvovirus Work-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4177.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">shop, Cryst\l River, Florida, Nov 7-5, 1993.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4189.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:322.35pt;top:4189.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:326.70pt;top:4189.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4189.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Brown KE, Green SW, Antunez de Mayolo J, et al. Congeni-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4201.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">tal anaemia after transplacental B19 parvovirus infection.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:336.00pt;top:4213.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Lancet 1994;343:895-6.</FONT></FONT></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:3456.00pt;z-index:-1;"><img style="width:720pt;height:864pt;" src="outputfile-613674016.htm_files\outputfile-613674016_background4.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:4320.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:369.60pt;top:4426.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">PARVOVIRUS B19 IN TRANSFUSION MEDICINE</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:375.10pt;top:5137.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Volume 41, January 2001 </FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:5137.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">TRANSFUSION </FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:527.80pt;top:5137.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1l</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:5137.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt"><a href="http://www.transfusion.org">www.transfusion.org</a></FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4465.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4465.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">4</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:68.70pt;top:4465.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4465.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Pattison JR, Jones SE, Hodgson J, et al. Parvovirus infections</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4477.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">and hypoplastic crisis in sickle-cell anaemia. Lancet</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4489.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1981;1:664-5.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4501.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4501.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">5.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4501.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Chorb\ T, Cocci\ P, Holman RC, et al. The role of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4513.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">parvovirus B19 in aplastic crisis and erythema infectiosum</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4525.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">(fifth disease). J Infect Dis 1986;154:383-93.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4537.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4537.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">6.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4537.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Kurtzman GJ, Ozawa K, Cohen B, et al. Chronic bone mar-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4549.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">row failure due to persistent B19 parvovirus infection. N</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4561.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Engl J Med 1987;317:287-94.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4573.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4573.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">7.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4573.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Kurtzman GJ, Cohen BJ, Field AM, et al. Immune response</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4585.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">to B19 parvovirus and an antibody defect in persistent viral</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4597.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">infection. J Clin Invest 1989;84:1114-23.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4609.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4609.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">8</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:68.70pt;top:4609.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4609.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Saikawa T, Anderson S, Momoeda M, et al. Neutralizing lin-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4621.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">ear epitopes of B19 parvovirus cluster in the VP1 unique</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4633.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">and VP1-VP2 junction regions. JVirol 1993;67:3004-9.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4645.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4645.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">9.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4645.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Agbandje M, Kajigaya S, McKenna R, et al. The structure of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4657.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">human parvovirus B19 at 8 A resolution. Virology</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4669.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1994;203:106-15.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4681.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4681.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:68.70pt;top:4681.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4681.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Bostic JR, Brown KE, Young NS, Koenig S. Quantitative</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4693.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">analysis of neutralizing immune responses to human</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4705.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">parvovirus B19 using a novel reverse transcriptase-poly-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4717.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">merase chain reaction-based assay. J Infect Dis</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4729.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1999;179:619-26.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4741.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4741.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4741.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">O’SClliv\n MG, Anderson DC, Fikes JD, et \l. Identific\tion</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4753.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">of a novel simian parvovirus in cynomolgus monkeys with</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4765.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">severe anemia: a paradigm of human B19 parvovirus infec-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4777.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">tion. J Clin Invest 1994;93:1571-6.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4789.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4789.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:68.70pt;top:4789.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4789.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">O’Sullivan MG, Veille JC, Block WA, et al. Hydrops fetalis</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4801.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">induced by simian parvovirus (abstract). Presented at the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4813.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">17th Annual Meeting, American Society for Virology,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4825.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Vancouver, BC, C\n\d\, July:99.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4837.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4837.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:68.70pt;top:4837.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4837.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Erdman DD. Human parvovirus B19: laboratory diagnosis.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4849.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">In: Anderson LJ, Young NS, eds. Monographs in virology:</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4861.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">human parvovirus B19. Basel: Karger, 1997:93-104.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4873.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4873.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">4</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:68.70pt;top:4873.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4873.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Azzi A, Morfini M, Mannucci PM. The transfusion-associ-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4885.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">ated transmission of parvovirus B19. Transfus Med Rev</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4897.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1999;13:194-204.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4909.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4909.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">5.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4909.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Cohen BJ, Beard S, Knowles WA, et al. Chronic anemia due</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4921.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">to parvovirus B19 infection in a bone marrow transplant</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4933.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">patient after platelet transfusion. Transfusion 1997;37:947-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4945.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">52.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4957.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4957.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">6.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4957.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Zanella A, Rossi F, Ces\n\ C, et al. Transfusion-transmitted</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4969.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">human parvovirus B19 infection in a thalassemic patient.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4981.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Transfusion 1995;35:769-72.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:4993.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:4993.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">7.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:4993.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Jordan J, Tiangco B, Kiss J, Koch W. Human parvovirus B19:</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:5005.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">prevalence of viral DNA in volunteer blood donors and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:5017.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">clinical outcomes of transfusion recipients. Vox Sang</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:5029.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">1998;75:97-102.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:5041.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:5041.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">8</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:68.70pt;top:5041.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:5041.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Wakamatsu C, Takakura F, Kpima E, et al. Screening of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:5053.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">blood donors for human parvovirus B19 and characteriza-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:5065.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">tion of the results. Vox Sang 1999;76:14-21.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:60.00pt;top:5077.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:64.35pt;top:5077.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">9.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:5077.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Nguyen QT, Sifer C, Schneider V, et al. Novel human</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:5089.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">erythrovirus associated with transient aplastic anemia. J</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:78.00pt;top:5101.95pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 8.00pt">Clin Microbiol 1999;37:2483-7.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4465.20pt;z-index:3;"><FONT FACE ="Utopia-Semibold" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">SPEAKERS</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4477.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Larry Anderson, MD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4489.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Respiratory & Enterovirus Laboratory</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4501.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">CDC</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4525.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">K</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:323.75pt;top:4525.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">evin E. Brown, MD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4537.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Hematology Branch</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4549.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">NHLBI, NIH</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4573.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Bernard J. Cohen, PhD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4585.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Enteric & RespiratoryVirus Laboratory</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4597.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Central Public Health Laboratory (UK)</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4621.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Roger Y.Dodd, PhD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4633.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Transmissible Diseases Department</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4645.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">American Red Cross</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4669.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Ted Eastlund, MD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4681.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Blood Bank</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4693.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">University of Minnesota Medical School</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4717.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Joan Pehta, MD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4729.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Vitex Technologies, Inc.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4753.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Harvey Klein, MD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4765.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Department of Transfusion Medicine</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4777.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Clinic\l Center, NIH</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4801.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">M</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:326.40pt;top:4801.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">argot Kruskall, MD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4813.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Division of LaboratoryTransfusion Medicine</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4825.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Beth Israel Hospital</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4849.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Naomi Luban, MD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4861.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Department of Laboratory Medicine</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4873.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Children’s National Medical Center</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4897.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Neil Young, MD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4909.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Hematology Branch</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4921.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">NHLBI, NIH</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4945.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Thomas J. Lynch, JD, PhD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4957.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Division of Hematology, FDA</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4981.20pt;z-index:3;"><FONT FACE ="Utopia-Semibold" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">ORGANIZERS</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:4993.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Barbara Alving, MD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:5005.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Division of Blood Diseases and Resources</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:5017.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">NHLBI, NIH</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:5041.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">L</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:323.05pt;top:5041.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">uiz H. Barbosa, DVM</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:5053.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Division of Blood Diseases and Resources</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:5065.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">NHLBI, NIH</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:5089.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">George J. Nemo, PhD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:5101.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">Division of Blood Diseases and Resources</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.00pt;top:5113.20pt;z-index:3;"><FONT FACE ="Utopia-Regular" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 9.00pt">NHLBI, NIH</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:370.30pt;top:5112.10pt;z-index:3;"><FONT FACE ="Wingdings-Identity-H" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 12.00pt">„</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:372.00pt;top:5113.45pt;z-index:3;"><FONT FACE ="Wingdings-Identity-H" style = "font-size: 12.00pt"><FONT COLOR="ffffff"><FONT STYLE="font-size: 8.00pt">6</FONT></FONT></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:4320.00pt;z-index:-1;"><img style="width:720pt;height:864pt;" src="outputfile-613674016.htm_files\outputfile-613674016_background5.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:5184.00pt"> </SPAN>
</BODY>
</HTML>