The association between viral infections and aplastic anemia: a comprehensive scoping review

Aplastic anemia (AA) is a rare hematological disorder characterized by bone marrow failure and pancytopenia, with viral infections implicated as a significant acquired cause. This scoping review evaluates the pathophysiological mechanisms linking viral infections to AA and assesses current therapeutic strategies for managing virus-associated cases. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a scoping review was conducted from April to May 2024 using PubMed, Google Scholar, Web of Science, and ScienceDirect. Eligible studies included those reporting viral infections associated with AA, diagnostic approaches, or therapeutic interventions. Data were extracted on study design, type of virus, diagnostic methods, and treatment strategies. A total of 48 studies were included, identifying parvovirus B19, Epstein-Barr virus, cytomegalovirus, human immunodeficiency virus, hepatitis viruses, human T-cell lymphotropic virus type 1, and SARS-CoV-2 as key pathogens. Rare cases of post-vaccination complications were also reported. Identified mechanisms include direct bone marrow suppression, immune-mediated destruction, and viral reactivation during immunosuppression. Antiviral therapies and hematopoietic stem cell transplantation constitute the primary treatments, and virological monitoring is essential to prevent reactivation. Viral infections play a significant role in AA etiology and progression. Tailored antiviral regimens and proactive virological monitoring are essential for optimizing outcomes. Future research should focus on longitudinal studies to clarify causal relationships and refine therapeutic approaches.