ABSTRACT
An impressive effect of the infection with SARS-Co-19 is the impairment of oxygen uptake due to lung injury. The reduced oxygen diffusion may potentially be counteracted by an increase in oxygen affinity of hemoglobin. However, hypoxia and anemia associated with COVID-19 usually decrease oxygen affinity due to a rise in [2,3-bisphosphoglycerate]. As such, COVID-19 related changes in the oxygen dissociation curve may be critical for oxygen uptake and supply, but are hard to predict. A Pubmed search lists 14 publications on oxygen affinity in COVID-19. While some investigations show no changes, three large studies found an increased affinity that was related to a good prognosis. Exact causes remain unknown. The cause of the associated anemia in COVID-19 is under discussion. Erythrocytes with structural alterations of membrane and cytoskeleton have been observed, and virus binding to Band 3 and also to ACE2 receptors in erythroblasts has been proposed. COVID-19 presentation is moderate in many subjects suffering from sickle cell disease. A possible explanation is that COVID-19 counteracts the unfavorable large right shift of the oxygen dissociation curve in these patients. Under discussion for therapy are mainly affinity-increasing drugs.
ABSTRACT
Patients with sickle cell disease (SCD) are more susceptible to severe coronavirus disease 2019 (COVID-19) infection, in comparison with the general population, due to the possibility that the inflammatory state, along with hypoxia and hypercoagulability may increase the risk of developing acute SCD-related complications. The present study reports the case of a 33-year-old female affected by SCD, who although vaccinated against COVID-19, tested positive for SARS-CoV-2 and developed febrile pneumonia. During hospitalization, the patient complained about generalized intense pain, along with fever recurrence and increased inflammatory marker, procalcitonin and haemoglobin S levels. The patient was treated with an intravenous analgesic therapeutics cocktail in combination with red blood cell manual exchange procedure and broad-spectrum antibiotic therapy, achieving the rapid resolution of pain and an improvement in the laboratory test results. From the case presented herein, it is thus suggested that patients with SCD and COVID-19 infection need to be critically evaluated by clinicians, as such patients may develop severe outcomes, attributed to the overlap of two difficult to treat conditions. © 2022 by the authors.
ABSTRACT
The novel COVID-19 infection has demonstrated a spectrum of complications involving vascular, inflammatory, infectious, and metabolic conditions. These complications range from mild loss of smell to more severe acute respiratory distress syndrome (ARDS). Patients with more severe complications often require sedation and mechanical ventilation. Growing research has revealed the role of active malignancy and disease-in-remission status as possible risk factors contributing to the morbidity and mortality inCOVID-19 patients. In our descriptive case series, we present three unique cases of complicated COVID-19 infection in patients with hematologic-oncologic risk factors and review the imaging features of their complications. The first patient was a 33-year-old male with sickle cell trait who developed rhabdomyolysis and myonecrosis of the paraspinal muscle in the setting of a physical fitness test;he subsequently developed an abscess at this site, presumably exacerbated by the hypoxemic state of his COVID-19 pneumonia. Our second patient was a 37-year-old male with COVID-19 pneumonia and a history of stage IV Non-Hodgkin's lymphoma in remission who developed spontaneous pneumomediastinum in the absence of positive pressure ventilation. The third COVID-positive patient was a 54-year-old male with a past medical history significant for grade 1 follicular non-Hodgkin's lymphoma in remission with sputum culture positive for mycobacterium avium complex and bronchoscopy positive for candida growth. 18-FDG/PET imaging was performed and demonstrated diffuse intense uptake throughout the lungs reflecting both the COVID-19pneumonia and the multimicrobial superinfection.