ABSTRACT
Case Report: A 25-year-old woman with history of Diamond-Blackfan anemia (DBA) presented with a 3- week history of weakness and fatigue. The patient was in her usual state of health until 3 weeks prior when she was diagnosed with COVID-19, at which time she experienced cough, congestion, weakness, and fatigue. She reported that the cough and congestion improved after a few days, but the fatigue and weakness progressively worsened. Admission labs were notable for a hemoglobin of 5.5 g/dL with a MCV of 119.3 fL. She received 2 units of packed RBCs with improvement in hemoglobin to 8.9 g/dL. The patient was diagnosed with DBA at birth via bone marrow biopsy and had been stable on chronic prednisone with a baseline hemoglobin around 8 g/dL. Prior to this admission, she has only required one transfusion at 3 months old. Her outpatient management involved close monitoring of her hemoglobin and increasing/decreasing prednisone based on her trending hemoglobin. She had been stable on 15 mg/day of prednisone for the past few years. Her hematologist was consulted, and the decision was made to increase her dose of prednisone to 20 mg/day resulting in resolution of symptoms and stabilization of her hemoglobin level. Discussion(s): We present a rare case of DBA with worsening anemia in the setting of a recent COVID-19 infection. The literature regarding the risk and complications of COVID-19 in these patients is severely limited, with no current data on disease management, outcomes, or predictors of morbidity. DBA is a rare, congenital erythroid red cell aplasia that typically presents in infancy with an estimated incidence of 5 cases per 1 million births. DBA is characterized by progressive macrocytic anemia, congenital malformations, and increased risk of endocrine dysfunction and malignancies. Glucocorticoids are the first-line therapy for DBA, although the exact mechanism of how they stimulate erythropoiesis in DBA remains unknown. In terms of patient prognosis, approximately 40% are steroid-dependent, 40% are transfusiondependent, and 20% go into remission by age 25 years. Copyright © 2023 Southern Society for Clinical Investigation.
ABSTRACT
Case Report A 25 year old woman, G3P2 at 23w6d presented to the Emergency Department for one week of progressive cough and shortness of breath. Patient was febrile, tachypnic, with oxygen desaturation to 88% with minimal exertion. Chest radiograph showed bilateral airspace disease consistent with viral pneumonia. The Patient was diagnosed with covid- 19 and admitted for acute hypoxic respiratory failure secondary and started on dexamethasone and remdesivir. The patient subsequently had escalating oxygen requirements and was stepped up to the ICU on BIPAP on hospital day two. Her oxygen requirements gradually improved, and she was stepped down to the floor on day 8 of admission on highflow nasal cannula. The following day, the patient was noted to have oxygen saturation of 97% on room air with a disposable finger probe applied to the forehead. Placement of the finger probe on the forehead is an uncommon practice reserved for use when unable to obtain adequate wave-form on the finger. A separate evaluation that day using a disposable finger probe on the finger revealed markedly different oxygen saturation in the low 90's. Confirmatory ABG showed pH 7.46, pCO2 31, O2 48, and HCO3 22. After determining hypoxemia, we placed disposable finger probes on both the finger and forehead at the same time using two separate machines. The probe on the forehead showed an spO2 consistently 10% higher than the reading on the finger. The probe connectors were switched and continued to show a 10% higher reading on the probe attached to the forehead. Discussion Given the hypoxemia confirmed on ABG, we concluded that the disposable finger probe used on the forehead provided a falsely elevated spO2 reading. One small study comparing disposable finger probes on the finger vs the forehead showed a discrepancy of >5% in over half of the patients. Critical management decisions are made based on the spO2, and inaccurate readings pose significant risk to the patient. Use of disposable finger probes on the forehead should be avoided.