The Course of COVID-19 in a Patient with Aplastic Anemia and Paroxysmal Nocturnal Hemoglobinuria Clone: A Case Report and Literature Review (original) (raw)
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Severe Hemolysis in a COVID-19 Patient with Paroxysmal Nocturnal Hemoglobinuria
Case Reports in Hematology, 2021
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has been demonstrated to be able to activate complement, making patients with deficiency in negative complement regulation, such as paroxysmal nocturnal hemoglobinuria (PNH), particularly vulnerable to complement-mediated cell damage. We report a case of a patient who presented with fatigue, facial swelling, and upper respiratory infection (URI) symptoms and was found to have COVID-19 with laboratory tests showing severe hemolysis and pancytopenia secondary to PNH.
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.
Severe Aplastic Anemia Secondary to SARS CoV-2 Infection-A Case Report
During the current COVID-19 pandemic, the assessment, and management of patients are challenging. The clinical features of COVID-19 are heterogeneous and subtle in many cases. Although Severe Acute Respiratory Syndrome Corona Virus 2 (SARS CoV-2) mainly affects pulmonary system, it has also been shown to cause abnormalities within the hematopoietic system by inducing neutropenia, lymphopenia, and in rare circumstances, central pancytopenia. Aplastic anemia is a potentially lifethreatening acquired bone marrow failure syndrome which leads to central pancytopenia. The association between SARS CoV-2 and aplastic anemia is insufficiently explored in the current literature. Although the exact pathogenesis of the disorder is yet to be fully understood, it is thought to be primarily caused by post infective auto-immunity. Based on a clinical case of COVID-19 induced severe aplastic anemia and the available literature on virus induced aplastic anemia, we propose that the development of aplastic anemia in COVID-19 patients may be attributable to SARS CoV-2. We here report a case of a previously normal 4 years old child who developed severe aplastic anemia after being hospitalized for COVID-19.
Infectious Disease Reports
Warm autoimmune hemolytic anemia (AIHA) is a rare complication of COVID-19 infection. We report a case of warm AIHA in a patient with COVID-19 pneumonia treated with methylprednisolone and several red blood cell transfusions. Despite treatment of the warm AIHA, the patient’s reticulocyte count remained low, and his biochemical markers were suggestive of pure red cell aplasia, which was later attributed to a concurrent parvovirus B19 infection. This case highlights an unusual situation of two separate hematological processes caused by two separate and simultaneous viral infections.
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-...
Clinicopathological Parameters of Haemolytic Anaemia in COVID-19 Infection: A Series of Three Cases
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2022
Coronavirus Disease 2019 (COVID-19) patients show various haematological abnormalities like cytopenia and coagulation disorders. Corona virus can induce an inflammatory state, leading to extensive coagulation manifestations. Association between COVID-19, Autoimmune Haemolytic Anaemia (AIHA) and thrombotic state is still the subject of extensive research. In this study, three cases of haemolytic anaemia are discussed. First case was a 28-year-old female with a history of abruptio placentae who presented with complaints of generalised weakness and oliguria for five days. She was diagnosed as thrombotic microangiopathy based on peripheral smear finding of schistocytes and spherocytes and few polychromatophils and normal prothrombin time (International Normalized Ratio (INR)) with very high D-dimer levels on coagulation profile. Second case was of a 25-year-old female who presented with complaints of fatigue, rashes, dark urine, nausea and abdominal pain. She was diagnosed as a case of ...
Hemoglobin and anemia in COVID19 patients
Hematology and Medical Oncology, 2020
Our aim is to evaluate the evolution of Hemoglobin (Hb) and iron parameters in COVID-19 patients to optimize the therapeutic management of anemia in these patients. Hb, s-Ferritin, transferrin saturation (TSAT), Haptoglobin, and inflammation markers were recorded. Correlation between parameters was studied using Pearson´s test. Comparison between data at admission and one week after hospitalization was evaluated using t-test for dependent data or Wilcoxon signed rank test. Significance level was fixed as P<0.05. 1,336 in-patients with COVID-19, 56.4% male and 43.6% females with an average age 62.9 years (sd 18.9). At admission mean Hb was 13.2 g/dL (standard deviation SD 1.6 g/dL), s-ferritin median 508 μg/L (25-75 interquartiles 460-876 μg/L) and transferrin saturation mean 19.3 % (SD 8%). All acute phase reactants had raised values. Hb showed a slow and progressive decrease in patients during admission, more marked in patients with severe symptoms and days warded; mean Hb was 12.5 g/dL (SD 1.8 g/dL) in general ward and 11.2 g/dL (SD 2.1 g/dL) at intensive care unit, p<0.05. Despite the significant inflammatory profile anemia in most patients is not severe, suggesting the use of iron and erythropoietin to prevent severe anemia in those patients.
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 |
Complete blood count alterations in COVID-19 patients
Biochemia medica, 2021
Coronavirus disease 2019 (COVID-19) pandemic represents a scientific and social crisis. One of the main unmet needs for coronavirus disease 2019 is its unpredictable clinical course, which can rapidly change in an irreversible outcome. COVID-19 patients can be classified into mild, moderate, and severe. Several haematological parameters, such as platelets, white blood cell total count, lymphocytes, neutrophils, (together with neutrophil-lymphocyte and platelet-lymphocyte ratio), and haemoglobin were described to be associated with COVID-19 infection and severity. The purpose of these review is to describe the current state of the art about complete blood count alterations during COVID-19 infection, and to summarize the crucial role of some haematological parameters during the course of the disease. Decreased platelet, lymphocyte, haemoglobin, eosinophil, and basophil count, increased neutrophil count and neutrophil-lymphocyte and platelet-lymphocyte ratio have been associated with C...