Severe Aplastic Anemia Secondary to SARS CoV-2 Infection-A Case Report (original) (raw)
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Dubai Medical Journal
Introduction: Aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH) are bone marrow failure syndromes. A 20–40% of patients with AA have a PNH clone at diagnosis. To date, there are little data about the course of COVID-19 in patients with AA and PNH. Case Presentation: A 36-year-old gentleman, who was previously diagnosed as a case of AA with PNH clones off immune-suppressive therapy, presented with fever and cough and was diagnosed with mild pneumonia due to COVID-19 with positive nasopharyngeal swab polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2. His clinical course was benign except transient thrombocytopenia. He was asymptomatic after day 4, and viral PCR was negative on day 21. Discussion: Though studies have shown that COVID-19 is associated with lymphopenia, our patient had a normal to high lymphocyte count. The neutrophil to lymphocyte ratio (NLR) was <1 during COVID-19, which correlates with the mild course of the diseas...
Haematologica, 2023
SARS-CoV-2, first recognized in December 2019 in Wuhan, China, was responsible for the largest global pandemic in recent history. Patients with hematological disease, including aplastic anemia (AA) and/or paroxysmal nocturnal hemoglobinuria (PNH) were considered potentially vulnerable, being advised to take precautions such as home isolation to reduce infection risk. 1 There are also often concerns about vaccination in this patient group, due to case reports of vaccination e.g., flu vaccination causing AA de novo, or disease relapse. 2-4 In addition, vaccination of patients with PNH, a highly hemolytic and thrombotic condition usually treated with complement inhibition, may cause potential issues of overwhelming hemolysis or thrombotic complications. 5 SARS-CoV-2 posed a potential life-threatening health risk to patients with AA and/or PNH, thus consensus advice was to proceed with vaccination in this cohort. 6 The Severe Aplastic Anemia Working Party and Infectious Diseases Working Party of European Society for Blood and Marrow Transplantation (EBMT) undertook an observational study of SARS-CoV-2 vaccination outcome to guide clinical practice which we report here, with the largest cohort of patients to date with aplastic anemia and/or PNH receiving SARS-Cov-2 vaccination. Disease-related outcome, vaccine complications including overall survival, comparison between those on immunosuppression and those not on immunosuppression and PNH-related complications were considered. All EBMT centers were invited to participate in this prospective observational study. Non-transplanted adult patients with AA and/or PNH invited to receive a SARS-CoV-2 vaccine were included. Patients consented to share their data with EBMT. Data was collected from January 2021 to September 2022 and included disease status, vaccinations received, vaccination side effects, blood parameters 3, 6 and 12 months post-vaccination with disease status at these time points, and SARS-CoV-2 infection occurrence. Four hundred and fifty-seven patients were included from 20 centers; 361 patients received at least one vaccination and were included for detailed analysis. See Table 1 for baseline characteristics. One hundred and thirty-nine patients were on active immunosuppression at first vaccination, and 120 patients on complement inhibitors with the majority on C5 inhibition (90.8%) (see Table 1). *Twenty-two patients were on immunosuppressive therapy (IST) treatment for aplastic anemia (AA) and complement inhibition. IQR: interquartile range; PNH: paroxysmal nocturnal hemoglobinuria. SARS-CoV-2 vaccination in 361 non-transplanted patients with aplastic anemia and/or paroxysmal nocturnal hemoglobinuria Haematologica |
Bone Marrow and Peripheral Blood Findings in Patients Infected by SARS-CoV-2
American Journal of Clinical Pathology, 2021
Objectives: Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with diverse clinical, including hematologic, abnormalities. We describe peripheral blood and bone marrow findings in deceased and living patients with COVID-19. Methods: We examined bone marrows from 20 autopsies and 2 living patients with COVID-19 using H&Estained slides and immunohistochemical stains. Clinical history and laboratory values were reviewed. HScore was calculated to estimate risk of hemophagocytic lymphohistocytosis (HLH). Results: The deceased patients included 12 men and 8 women (aged 32 to >89 years; median, 63 years). Hematologic abnormalities included frequent neutrophilic leukocytosis, lymphopenia, anemia, and thrombocytopenia; one patient showed striking erythrocytosis. The bone marrows were all normocellular to hypercellular, most showing maturing trilineage hematopoiesis with myeloid left shift. In all 19 evaluable bone marrows, hemophagocytic histiocytes were identified. The HScore for secondary HLH ranged from 35 to 269 (median, 125; >169 in 5 patients). Coinfections were identified in 6 patients. In 2 living patients, bone marrow showed maturing trilineage hematopoiesis, including one showing few hemophagocytic histiocytes. Conclusions: Peripheral blood from deceased patients with COVID-19 frequently showed neutrophilic leukocytosis, lymphopenia, and, rarely, secondary polycythemia; hemophagocytosis was common in their bone marrow. Consistent with other studies, we provide histopathologic evidence of secondary HLH development in patients with COVID-19. Key Points • We noted a high incidence of hemophagocytosis in the bone marrow from patients with coronavirus disease 2019 (COVID-19) who underwent autopsy (100% of 19 evaluable marrows). • Common hematologic abnormalities in patients with fatal COVID-19 included neutrophilic leukocytosis, lymphopenia, and anemia. • Our findings provide histopathologic data to support secondary hemophagocytic lymphohistiocytosis as one of the manifestations of COVID-19.
Hemolytic Anemia Complicating COVID-19 Infection
Journal of Hematology, 2021
Coronavirus disease 2019 (COVID-19) has been associated with a spectrum of reported hematological complications ranging from immune cytopenias to thromboembolic manifestations of coagulopathy. Moreover, there have been documented cases of hemolytic anemia associated with COVID-19 infection which have been mainly attributed to development of autoantibodies. We report a case of an African-American patient who presented with hemolytic anemia in the second week after his COVID-19 diagnosis. Throughout this report, we explore the potential immune and non-immune etiologies that contributed to the patient's hemolytic anemia in the setting of COVID-19 infection guided by a review of literature.
Pancytopenia Secondary to SARS-CoV-2 Infection—a Case Report
SN Comprehensive Clinical Medicine, 2022
Pancytopenia is a condition when a person has a low count of all three types of blood cells, causing a triage of anaemia, leukopenia and thrombocytopenia. It should not be considered a disease in itself but rather a sign of a disease that needs to be further evaluated. Among the various causes, viral infections like the human immunodeficiency virus, cytomegalovirus, Epstein-Barr virus and parvovirus B19 have been implicated. Pancytopenia is a rare complication and is not commonly seen in patients with COVID-19 disease. Here, we report a case of pancytopenia in a previously immunocompetent elderly male patient with SARS-CoV-2 infection. Keywords Pancytopenia • SARS-CoV-2 infection • COVID 19 disease This article is part of the Topical Collection on COVID-19
SARS-CoV-2 infection in a child with Fanconi anemia and determined immunosuppressed status
Romanian Journal of Infectious Diseases
Introduction. SARS-CoV-2 virus infection affects all age groups. In children, the infection mainly causes asymptomatic or mildly symptomatic forms of the disease, regardless of their immune status. Case presentation. We describe the case of a 7-year-old male child, known to have Fanconi anemia, scheduled for bone marrow transplantation. The patient comes from a family outbreak of COVID-19, which is why he was tested for SARS-CoV-2 infection. He is asymptomatic at the time of admission to our clinic. The clinical examination performed at the time of admission shows a patient in good general condition, afebrile, with pale skin and mucous membranes, without respiratory changes. Paraclinically, severe neutropenia, severe normochromic normocytic anemia and severe thrombocytopenia are detected, for which transfusions of erythrocyte mass and platelet mass are performed. Due to the immunocompromised status, antibiotic therapy is instituted. If necessary, symptomatic treatment is administere...
Pancytopenia Secondary to SARS-CoV 2 Infection-A Case Reprt
2021
Pancytopenia is a condition when person has low count of all three types of blood cells causing a triage of anemia, leukopenia and thrombocytopenia. It should not be considered as a disease in itself but rather the sign of a disease that needs to be further evaluated. Among the various causes, viral infections like Human Immunodeficiency Virus, Cytomegalovirus, Epstein-Barr virus and Parvovirus B19 have been implicated. Pancytopenia is a rare complication and not commonly seen in patients with COVID 19 disease. Here, we report a case of pancytopenia in previously immunocompetent elderly male patient with SARS-CoV2 infection.
Anemia in patients with Covid-19: pathogenesis and clinical significance
Clinical and Experimental Medicine
COVID-19 patients typically present with lower airway disease, although involvement of other organ systems is usually the rule. Hematological manifestations such as thrombocytopenia and reduced lymphocyte and eosinophil numbers are highly prevalent in COVID-19 and have prognostic significance. Few data, however, are available about the prevalence and significance of anemia in COVID-19. In an observational study, we investigated the prevalence, pathogenesis and clinical significance of anemia among 206 patients with COVID-19 at the time of their hospitalization in an Internal Medicine unit. The prevalence of anemia was 61% in COVID-19, compared with 45% in a control group of 71 patients with clinical and laboratory findings suggestive of COVID-19, but nasopharyngeal swab tests negative for SARS-CoV-2 RNA (p = 0.022). Mortality was higher in SARS-CoV-2 positive patients. In COVID-19, females had lower hemoglobin concentration than males and a higher prevalence of moderate/severe anemia (25% versus 13%, p = 0.032). In most cases, anemia was mild and due to inflammation, sometimes associated with iron and/or vitamin deficiencies. Determinants of hemoglobin concentration included: erythrocyte sedimentation rate, serum cholinesterase, ferritin and protein concentrations and number of chronic diseases affecting each patient. Hemoglobin concentration was not related to overall survival that was, on the contrary, influenced by red blood cell distribution width, age, lactate dehydrogenase and the ratio of arterial partial oxygen pressure to inspired oxygen fraction. In conclusion, our results highlight anemia as a common manifestation in COVID-19. Although anemia does not directly influence mortality, it usually affects elderly, frail patients and can negatively influence their quality of life. Keywords COVID-19 • Anemia • Oxygen partial pressure/oxygen concentration • Red blood cell distribution width • Anemia of inflammation * Gaetano Bergamaschi
Case fatality rate in patients of COVID-19 with anemia
The Professional Medical Journal
Objective: To analyze SARS-CoV2 patients who presented to Military Hospital Rawalpindi having normal hemoglobin levels and those with low hemoglobin. Study Design: Cross Sectional study. Setting: Pathology Laboratory, Military Hospital Rawalpindi, Pakistan. Period: March 2020 to July 2020. Material & Methods: Patients of both genders and all age groups with positive PCR for Corona virus were included. Patients of both the genders and all age groups with negative PCR for corona virus. 2ml blood sample was taken in EDTA tubes from the patients in wards and Intensive care unit and Hemoglobin level was checked using the Sysmex KX21 analyzer. Results: 400 COVID positive patients were studied with Hemoglobin ranging from 7.0g/dl to 17g/dl. It was seen that patients with low Hemoglobin levels were increasingly shifted to ventilators as compared to those with normal Hemoglobin whereas, the Ferritin level was raised in patients who expired. Conclusion: Most patients who expired due to COVID-...