Iron deficiency anemia and COVID-19

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a significant health and financial issue in the current century. Despite significant attempts to manage the illness, the transmission routes of the virus and its widespread genomic mutations have led to an increasing number of new infections and mortality rates. In the absence of specific treatment for this new virus, identifying and managing factors affecting the prognosis of the disease is one of the critical strategies to reduce disease mortality. Patients with iron deficiency anemia (IDA), who account for an estimated half a billion people globally, are more prone to infections due to immune system disorders. Since they visit hospitals more frequently for follow-up care and diagnosis, they are more susceptible to becoming infected with SARS-CoV-2. Once infected with SARS-CoV-2, low hemoglobin (Hb) levels and compromised immune systems disrupt the restriction of infection in these individuals, ultimately leading to severe complications of COVID-19.

Impact of Maternal Health and Disease on Neonatal Outcome

Low birth weight (LBW) and preterm births make babies more vulnerable for disease and death in the neonatal period in India and worldwide (Estimates generated by the WHO and Maternal and Child Epidemiology Estimation Group (MCEF) 2018: leading causes of neonatal deaths in India. http://data.unicef.org). Of the 20 million LBW babies born globally each year, 97% are born in low-middle income countries (40% in India), and 80% of neonatal deaths occur in this group. Unlike LBW, preterm births are prevalent in both high- and low-income countries and are the most common cause of disability and death. Of more than 15 million preterm births (10.6% of total live births), 81% are in Asia and sub-Saharan Africa. In India, premature birth rate is 14 per 1000 live births. Worldwide, 10% of all neonatal deaths occur in premature births (in Indian up to 44% mortality). This risk is on the rise with the increase in preterm birth rate in many countries. Neonatal mortality rate (NMR) is an indicator of a country's health status. Indian NMR has decreased from 5.7% to 4.1% over 10 years, as in 2017 (Estimates generated by the WHO and Maternal and Child Epidemiology Estimation Group (MCEF) 2018: leading causes of neonatal deaths in India. http://data.unicef.org). Of the various factors impacting NMR, maternal factors (undernutrition, anaemia, and diseases) are most important affecting fetal growth, maturation, and overall neonatal outcome. Surgical mortality in neonates is also very high, varying on a country's health infrastructure and development, ranging from 6.7% in South Korea (Lee et al., J Korean Assoc Pediatr Surg 2006, http://www.koreamed.org/SearchBasic.php?RID=0053JKAPS/2006.12.2.137andDT=1) to 7.5% in Japan (Taguchi, Surg Today 38:379-89, 2008) and 35% in India (Gangopadhyay et al., Indian J Pediatr 75:1025-30, 2008) to 45% in Nigeria (Chirdan et al., Semin Pediatr Surg 21:151-9, 2012). This chapter will discuss the impact of maternal health and common medical diseases on fetal growth and development and the risks in the baby after birth. This will also affect perioperative morbidity and mortality in the surgical neonates. © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.

Associations of anemia and blood transfusions with mortality in old, critically ill COVID-19 patients - Results from the prospective COVIP Study.

AIMS: Anemia is common in the old and often observed in critically ill patients. Increased age is associated with higher mortality following a COVID-19 infection, making old patients prone to poor outcomes. We investigated whether anemia at admission to the ICU or the need for blood transfusion was associated with 90-day mortality in older, critically ill COVID-19 patients. METHODS: In this prospective multicenter study, the 90-day mortality of COVID-19 patients≥70 years treated in 138 intensive care units (ICU) was analyzed. Associations between anemia (WHO definition) at admission and discharge from ICU and the use of red blood cell (RBC) transfusions with mortality were assessed. Hemoglobin thresholds of RBC transfusions in old, critically ill COVID-19 patients were recorded. RESULTS: In 493 patients (350 anemic, 143 non-anemic), anemia (WHO definition) at the time of ICU admission was not associated with impaired overall survival. Transfusion and severe anemia (hemoglobin≤10 g/dL) at ICU discharge were independently associated with a higher risk of 90-day mortality. CONCLUSION: The need for red blood cell transfusions and severe anemia at ICU discharge, but not at the timepoint of admission, were independently associated with 90-day mortality in critically-ill old COVID-19 patients.

Enhanced IgG immune response to COVID-19 vaccination in patients with sickle cell disease.

Patients with sickle cell disease (SCD) are considered to be immunocompromised, yet data on the antibody response to SARS-CoV-2 vaccination in SCD is limited. We investigated anti-SARS-CoV-2 IgG titres and overall neutralizing activity in 201 adults with SCD and demographically matched non-SCD controls. Unexpectedly, patients with SCD generate a more robust and durable COVID-19 vaccine IgG response compared to matched controls, though the neutralizing activity remained similar across both cohorts. These findings suggest that patients with SCD achieve a similar antibody response following COVID-19 vaccination compared to the general population, with implications for optimal vaccination strategies for patients with SCD.

Anaemia of acute inflammation: a higher acute systemic inflammatory response is associated with a larger decrease in blood haemoglobin levels in patients with COVID-19 infection.

AIMS: The study tests the hypothesis that a higher acute systemic inflammatory response was associated with a larger decrease in blood hemoglobin levels in patients with Coronavirus 2019 (COVID-19) infection. METHODS: All patients with either suspected or confirmed COVID-19 infection admitted to a busy UK hospital from February 2020 to December 2021 provided data for analysis. The exposure of interest was maximal serum C-reactive protein (CRP) level after COVID-19 during the same admission. RESULTS: A maximal serum CRP >175mg/L was associated with a decrease in blood haemoglobin (-5.0 g/L, 95% confidence interval: -5.9 to -4.2) after adjustment for covariates, including the number of times blood was drawn for analysis.Clinically, for a 55-year-old male patient with a maximum haemoglobin of 150 g/L who was admitted for a 28-day admission, a peak CRP >175 mg/L would be associated with an 11 g/L decrease in blood haemoglobin, compared with only 6 g/L if the maximal CRP was <4 mg/L. CONCLUSIONS: A higher acute systemic inflammatory response is associated with larger decreases in blood haemoglobin levels in patients with COVID-19. This represents an example of anaemia of acute inflammation, and a potential mechanism by which severe disease can increase morbidity and mortality.

Comparative study of feto-maternal outcome of ante-natal cases as per the standard WHO guidelines vs revised antenatal visit schedule during COVID19 pandemic

Background: Good antenatal care helps a woman face labour in good health and optimum conditions. The National Institute for Health and Care Excellence (NICE) and WHO guidelines suggest 15 visits in the whole pregnancy. Keeping in view the COVID-19 pandemic to reduce the exposure of pregnant ladies the number of antenatal visits was reduced to 7 milestone visits and outcome was noted. This study aimed to do a comparative study of feto-maternal outcome in antenatal cases at our centre using standard WHO protocol vs. revised antenatal protocol during COVID-19 pandemic. Subjects and Method: This was an observational study done at a tertiary care center of an Armed forces hospital with target population as pregnant ladies attending antenatal care Out patient department of the hospital during COVID19 pandemic Vs Antenatal cases in previous 1 year. A comparative analysis of pregnancy outcome, maternal variables during pregnancy and delivery along with neonatal variables was done. Results: There were lesser deliveries by 41.7% as compared to non-COVID times. There was an increase in the caesarean delivery rate and instrumental delivery rate during COVID times by 11% and 53% respectively. There was increase in Vaginal birth after caesarean (VBAC) by 26.6%. The incidence of fetal growth restriction, placental abruption, maternal anaemia and gestational diabetes mellitus, oligohydramnios and polyhydramnios was low. The incidence of spontaneous abortions was also low in our study. In contrast, the incidence of pre-term deliveries doubled from 7.4% to 13.4%. Neonatal morbidity and mortality indicators like Neonatal Intensive care unit (NICU) admissions showed a rising trend of 1.7% during the COVID (14.6% to 16.3%) with a minimal rise in early neonatal deaths by 0.2%. Conclusion: Our model doesn't show an increase in maternal, neonatal morbidity, and mortality. This model can be used as a standard of care for Antenatal patients during Pandemics. It reduces the risk exposure of the gravid mother without any significant increase in maternal and neonatal morbidity and mortality.

Furosemide-induced haemolytic anaemia in an extreme elderly patient.

Furosemide, a loop diuretic, is commonly used to treat fluid overload symptoms and heart failure. Drug-induced immune haemolytic anaemia is an unusual drug-adverse event. Furosemide-induced haemolysis is even rarer. This case report presents a 91-year-old male who developed acute haemolytic anaemia 3 days after initiating furosemide to treat myocardial infarction complicated with acute decompensated heart failure. He had increased lactate dehydrogenase and unconjugated bilirubin with undetectable haptoglobin, which indicated the destruction of red blood cells. Other causes for haemolytic anaemia, including hereditary, microangiopathic haemolytic anaemia, and paroxysmal nocturnal haemoglobinuria, were also excluded. He improved with drug cessation and a short course of glucocorticoids. This report aims to raise awareness of this rare complication caused by commonly prescribed drugs. Despite a negative result of a direct antiglobulin test, physicians must remain suspicious of drug-induced immune haemolytic anaemia in unclear cases of haemolysis.

Extensive Lower Lip Squamous Cell Carcinoma in a Fanconi Anaemia Patient and Treatment Delays during COVID-19 Pandemic.

Fanconi anaemia (FA) is an autosomal recessive inherited disease that renders patients susceptible to congenital anomalies, bone marrow failures, leukaemia, and solid malignancies. FA is caused by the loss of function of at least one gene in the FA/BRCA biological pathway, which is involved in DNA repair. Patients with FA have an increased risk of developing head and neck cancer, particularly oral squamous cell carcinoma (SCC). Due to susceptibility of head and neck cancer at a very young age, relatively poor survival rate, low tolerance to oncologic interventions, and complexity of treatments, strict follow-up is mandatory to detect any changes or recurrence of SCC in the head and neck region in FA patients. Surgery is the mainstay of treatment, but adjuvant therapy should be instituted when needed. This short report describes a rare case of lower lip SCC in FA and its management. It also highlights the impact of the COVID-19 pandemic on healthcare practices.

Clinical outcomes and immune responses to SARS-CoV-2 vaccination in severe aplastic anaemia.

Patients with severe aplastic anaemia (SAA) are often not vaccinated against viruses due to concerns of ineffective protective antibody response and potential for pathogenic global immune system activation, leading to relapse. We evaluated the impact of COVID-19 vaccination on haematological indices and disease status and characterized the humoural and cellular responses to vaccination in 50 SAA patients, who were previously treated with immunosuppressive therapy (IST). There was no significant difference in haemoglobin (p = 0.52), platelet count (p = 0.67), absolute lymphocyte (p = 0.42) and neutrophil (p = 0.98) counts prior to and after completion of vaccination series. Relapse after vaccination, defined as a progressive decline in counts requiring treatment, occurred in three patients (6%). Humoural response was detectable in 90% (28/31) of cases by reduction in an in-vitro Angiotensin II Converting Enzyme (ACE2) binding and neutralization assay, even in patients receiving ciclosporin (10/11, 90.1%). Comparison of spike-specific T-cell responses in 27 SAA patients and 10 control subjects revealed qualitatively similar CD4+ Th1-dominant responses to vaccination. There was no difference in CD4+ (p = 0.77) or CD8+ (p = 0.74) T-cell responses between patients on or off ciclosporin therapy at the time of vaccination. Our data highlight appropriate humoural and cellular responses in SAA previously treated with IST and true relapse after vaccination is rare.

Autoimmune haemolytic anaemia and immune thrombocytopenia following SARS-CoV-2 and non-SARS-CoV-2 vaccination: 32 Years of passive surveillance data.

Autoimmune haemolytic anaemia (AIHA) and immune thrombocytopenia (ITP) are two uncommon haematologic autoimmune conditions that can rarely arise secondary to vaccination. Prior studies using the US Centers for Disease Control's (CDC) Vaccine Adverse Event Reporting System (VAERS) have demonstrated this infrequency, but contemporary data as well as comparison with current information regarding SARS-CoV-2 vaccination has not been assessed. In this study, we reviewed VAERS database reports from 1990 to 2022 to characterize the incidence and clinical and laboratory findings of non-SARS-CoV-2-associated AIHA and ITP and SARS-CoV-2 vaccine-associated AIHA and ITP. We discovered a total of 863 AIHA and ITP reports following vaccination with 15 non-SARS-CoV-2 and four SARS-CoV-2 vaccines submitted to the CDC VAERS database. AIHA and ITP reporting was low for both groups, with a large proportion excluded due to a lack of clinical details. ITP was reported the most frequently in both groups and was significantly more common with measles-mumps-rubella (MMR) vaccination (p < 0.001) in the non-SARS-CoV-2 group. AIHA and ITP cases were higher in the SARS-CoV-2 vaccine group, though ultimately still very infrequent. Autoimmune haematologic disease is vanishingly rare after immunization and rates are lower than in the general population according to passive reporting.

High anti-SARS-CoV-2 seroprevalence among unvaccinated mother-child pairs from a rural setting of north-eastern Tanzania during the second wave of COVID-19.

Background: The reported infection rates, and the burden of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in low- and middle-income countries, including sub-Saharan Africa, are relatively low compared to Europe and America, partly due to limited testing capabilities. Unlike many countries, in Tanzania, neither mass screening nor restrictive measures such as lockdowns have been implemented to date. The prevalence of SARS-CoV-2 infection in rural mainland Tanzania is largely unknown. Methods: Between April and October 2021, we conducted a cross-sectional study to assess anti-SARS-CoV-2 seroprevalence among mother-child pairs (n=634 children, n=518 mothers) in a rural setting of north-eastern Tanzania. Findings: We found a very high prevalence of anti-SARS-CoV-2 antibody titres with seroprevalence rates ranging from 29% among mothers and 40% among children, with a dynamic peak in seropositivity incidence at the end of July/early in August being revealed. Significant differences in age, socioeconomic status and body composition were associated with seropositivity in mothers and children. No significant associations were observed between seropositivity and comorbidities, including anaemia, diabetes, malaria, and HIV. Interpretations: The SARS-CoV-2 transmission in a rural region of Tanzania during 2021 was high, indicating a much higher infection rate in rural Tanzania compared to that reported in the UK and USA during the same period. Ongoing immune surveillance may be vital to monitoring the burden of viral infection in rural settings without access to molecular genotyping where a load of communicable diseases may mask COVID-19. Surveillance could be implemented in tandem with the intensification of vaccination strategies.

Psychological, Medical and Laboratory Predictors of Cardiac Anxiety in Patients with Heart Failure During the COVID-19 Pandemic

Objective: The aim of the study was to identify predictors of heart-focused anxiety in patients with heart failure. A better understanding of such predictors may help in detecting the comorbidity underlying heart-focused anxiety and identifying patients who need psychological help. Methods: In order to account for multiple sources of heart-focused anxiety, we included psychological, lifestyle, and medical/laboratory predictors. The study involved 148 patients, of whom 74 had a leading diagnosis of worsening heart failure and were hospitalized during the COVID-19 epidemic. A second group of 74 patients suffering from cardiovascular diseases without a diagnosis of acute heart failure, were examined in various out-patient cardiology clinics. The sample consisted of 37.8% females and 62.2% males, with an average age of 63.35 years. The patients completed the Cardiac Anxiety Questionnaire, the Generalized Anxiety Disorder scale, the Patient Health Questionnaire, and the Intolerance of Uncertainty Scale. Results: Patients with heart failure with higher levels of depression and intolerance of uncertainty had higher overall levels of heart-focused anxiety, higher levels of fear about chest and heart sensations. Older patients with higher levels of depression had higher levels of activity avoidance, especially activities believed to elicit cardiac symptoms. Cardiac patients with higher level of anxiety and with anaemia as comorbidity had higher levels of heart-focused attention and monitoring of cardiac activity. Conclusion: In patients with heart failure, the presence of heart-focused anxiety significantly reduces the quality of life, leads to avoidant behaviours, and is associated with anxiety and depressive symptoms. These patients are more likely to seek medical help and specialist services, but the need for psychological help is very rarely recognized.

Anaemia can be improved by controlling the disease activity of Takayasu's arteritis without iron administration.

BACKGROUND: Anaemia is a common clinical manifestation observed in Takayasu's arteritis (TAK), but few studies have been conducted. This study investigated whether improvement of inflammatory indicators was associated with improvement of anaemia in TAK. We also investigated whether iron supplement treatment could benefit in addition to immunosuppressant therapy in the anaemia patients with TAK. METHODS: This was a retrospective cohort study of 160 patients diagnosed with TAK. All patients were further assigned into anaemia group (67 cases) or non-anaemia group (93 cases) according to their haemoglobin levels. Fifty two anaemia patients completed follow-up (median 5.2 months). RESULTS: There were 67 (41.88%) anaemia patients among all 160 TAK patients. Compared to TAK patients without anaemia, the average age [32 (24, 45) vs. 40 (31, 48), p = 0.002], disease duration [36 (7, 120) vs. 72 (14, 162), p = 0.017] and BMI [21.43 (18.96, 23.81) vs. 22.86 (20.09, 25.81), p = 0.008] were significantly lower in TAK patients with anaemia. The levels of ESR [23 (15, 51) vs. 11 (5.5, 22), p = 0.0001] and CRP [9.33 (1.99, 27.8) vs. 1.99 (0.45, 6.68), p = 0.0001] were significantly increased in TAK patients who complicated with anaemia. After follow-up, decrease of ESR, CRP and disease activity score (NIH and ITAS) were significantly associated with improvement of anaemia. One unit decrease of ESR and CRP, the hazard ratio of the improvement rate of anaemia was 1.02 [95% CI (1.00, 1.03); p = 0.027] and 1.04 [95% CI (1.02, 1.07); p < 0.001] respectively. One point decrease of NIH and ITAS-A was associated with a higher probability of anaemia improvement [HR 95% CI: 1.25 (1.02, 1.41), p = 0.022, HR 95% CI: 1.62 (1.21, 2.17), p = 0.001]. These relationships were consistent between iron supplement treatment group and without iron supplement treatment group. We found no significant difference in cumulative hazard between the two groups (p = 0.692). CONCLUSION: Anaemia was a common complication in TAK. Decrease of ESR, CRP and disease activity score (NIH and ITAS) were significantly associated with improvement of anaemia, even after adjusting for various covariates. Moreover, these relationships were consistent between iron supplement treatment group and without iron supplement treatment group. There was no significant difference in the improvement of anaemia in patients receiving immunosuppressant therapy with or without iron supplement treatment.

A rare presentation of Multisystem Inflammatory Syndrome in Neonates (MIS-N) with a cerebral haemorrhage

Covid-19 infection during pregnancy poses diverse challenges to the developing fetus1. Multisystem Inflammatory Syndrome in Children (MIS-C) usually develops around 4-8 weeks after Covid-19 infection due to immune dysregulation2. Pathogenesis of MIS-N is similar to MIS-C but the Covid-19 infection occurs in the mother while the multiorgan inflammation occurs in the neonate due to the transfer of maternal antibodies3. Gastrointestinal bleeding and thrombotic events are known associations of MIS-N3;however, there are only a few cases with cerebral haemorrhage4. We describe a case of MIS-N with cerebral haemorrhage and microangiopathic haemolytic anaemia (MAHA) that showed a good response to immunotherapy with intravenous immunoglobulin (IVIG) © Open Access Article published under the Creative Commons Attribution CC-BY License

The Impact of Antithrombotic Therapy in Patients with Decompensated Heart Failure and Iron

The iron deficient anaemia is a common medical condition in patients with heart failure receiving antithrombotic therapy. Especially during the COVID19 pandemic period the rate of bleeding complications associated with the antithrombotic therapy tend to be higher, as the patient's referral to medical services is lower and the interaction doctor-patient is limited. In our retrospective observational study we included 300 consecutive patients with decompensated heat failure associating iron deficient anaemia. For defining the medical conditions we used the ESC guidelines terminology and diagnostic criteria. We assessed the association between the iron deficient anaemia and different antithrombotic therapies, recommended in concordance to ESC Guidelines. We found that aspirin 75mg/day was statistical significant associated with iron deficient anaemia (p 0.012) and anaemia severity (p 0.002), this association being assessed by Chi square and Pearson tests. Also, neither clopidogrel, ticagrelor, VKA or non-VKA were associated to the presence of anaemia. By assessing the mortality rate associated to anaemia severity, the severe anaemia was associated to higher mortality rate, meanwhile no antithrombotic therapy was associated with higher readmission or mortality rate (p<0.001). In conclusion, aspirin was the only antithrombotic therapy associated with the presence of anaemia and anaemia severity, while only severe anaemia was associated with statistic significant increase of patient's mortality, with nonstatistical result regarding the readmission rate. This finding is concordant to the necessity of a permanent evaluation of the antithrombotic therapy in heart failure patients.

Analysis of first apheresis services in Ghana-Greater Accra Regional Hospital.

Background: At the combined American Society for Apheresis (ASFA) annual meeting and World Apheresis Association (WAA) Congress in 2014, it was observed that there were significant disparities with regard to the access of apheresis services within and across developing countries, with only few of such facilities available in Africa; notably South Africa and Nigeria. In 2019, Bone Marrow Transplantation (BMT) Unit-Ghana, acquired an apheresis machine. By the collaboration between BMT-Ghana, the Greater Accra Regional Hospital (GARH) and the Ministry of Health (Ghana), apheresis services is now available in Ghana. The aim of this paper is to present an analysis of apheresis services so far in Ghana. Method: A 12-month period from 2019 to 2021 was examined (less the period of the COVID-19 outbreak when the Unit was virtually at a standstill). The electronic database and hard copies of documented activities were analysed. Basic information on demographics and procedure types and counts was used. Results: The retrospective study encompassed data of 43 patients. Two (2) patients came from the West Africa sub-region (Nigeria and Cameroon) with the rest from 6 out of the 14 regions of Ghana (Greater Accra, Western, Central, Eastern, Ashanti, Volta). The essential nature of the apheresis services being the first in Ghana, brought patients as far as 315 km from the hinterlands to the Unit. Ages ranged from 2-52 years with a mean of 16.3 ± 15.3 years. Slightly more females (n = 23, 53%) received services than males (n = 20, 47%). Eighty-six percent (n = 37, 86%) of the patients were sickle cell patients referred to the Unit. Red Blood Cell exchange (RBCx) accounted for 87% (n = 40), of the 46 procedure counts followed by Continuous Mononuclear Cell Collection (CMNC) (n = 4, 9%) and lastly, Therapeutic Plasma Exchange (TPE) (n = 2, 4%). Conclusion: Ghana can now be counted among African countries offering apheresis services and the GARH is acknowledged as the only hospital in the country with this facility, thus improving patient care significantly.

COVID and women's health in India

Background : COVID-19 disease surfaced in Wuhan in December, 2019 and rapidly spread in the World as a pandemic (March, 2020) Till date (10 August) COVID-19 has affected 20 million people. Many women have delivered and many conceived during this time. Till date very few adverse effects and vertical transmission is observed. WHO later changed the terminology to SARS-COV-2 and removed '19' from the name. Material and Method : We studied Maternal and Perinatal outcome of COVID confirmed pregnancies and the effects of CORONA infections on Women's Health. Results : Most of the patients were asymptomatic. Majority 80% cases of our cases were delivered by Cesarean Section. Cesarean Section was done for Obstetric reasons along with early consideration due to COVID concerns. Meconium Stained Liquor and Fetal Distress was the indication of Cesarean in 14% cases. Previous Cesarean Sections was a major cause of repeat cesarean in our study. Preterm labour was reported in only one case of Twin Pregnancies. Premature Rupture of Membranes was not seen in any of the pregnancies. Maternal and Fetal outcome were favorable with only few cases of mild to moderate Pneumonia in mothers. Most of the women were psychological disturbed due to the Lockdown and had unwanted pregnancy (due to lack of contraceptive availability), domestic violence and also family disputes and child beating were reported by many in the survey. Due to lack of Medical Services by the GP's and the friendly small Obstetrics Gynaecology clinics (closed due to Lockdown) small problems got aggravated and a lot of these women one now coming up with Anemia, Polycystic Ovarian Syndrome (PCOS), Fibroids, Abnormal Uterine Bleeding (AUB), Endometriosis, Pelvic Inflammatory Disease (PID), Cervical Crosiers, Vaginitis, Obesity etc. Conclusion : Coronavirus infection in pregnancy did not adversely affect the pregnancy and has a benign course. Pregnant women are not at higher risk of developing Pneumonia compared to non pregnant women. There is no evidence of increased risk of miscarriage or foetal losses with COVID-19 infection during pregnancy. But SARS-COV- 2 disease a lot of other Gynaecological problems and adversely affected Women's Health.

Pancytopenia in a Case of Aplastic Anaemia/Paroxysmal Nocturnal Haemoglobinuria Unmasked by SARS-CoV-2 Infection: A Case Report.

During an acute SARS-CoV-2 infection, a diagnosis of Aplastic Anaemia associated with Paroxysmal Nocturnal Haemoglobinuria (AA/PNH) was made in a 78-year-old woman who had presented to the emergency department with severe pancytopenia. It is possible that she had subclinical AA/PNH that was unmasked during the acute COVID-19 infection, but we can also suspect a direct role of the virus in the pathogenesis of the disease, or we can hypothesize that COVID-19 infection changed the phosphatidylinositol glycan class A (PIGA) gene pathway.

Differences in Prevalence of Haematological Abnormalities on Presentation to Hospital in COVID 19 Infected adult and Paediatric Patients: A Retrospective Multicenter Descriptive Study

Background: It is well known that COVID 19 infection affects multiple systems in the body. Reports have documented many changes in the hematopoietic system in the pathophysiology of the disease. Aim: The aim of the study was to find out the prevalence and any significant difference in routine haematological parameters on presentation in Paediatric and adult patients with COVID 19 infection. Methodology: We conducted a multicenter retrospective descriptive observational study and investigated the prevalence of haematological abnormalities at presentation of 1000 PCR swab confirmed COVID 19 infected randomly selected adult and Paediatric patients admitted to 3 tertiary hospital in Dubai. Data was gathered through their electronic medical records and all analysis was done using the Statistical Package for the Social Sciences software (SPSS). Results: The prevalence of at least one abnormal haematological parameter was 95.1% (794/835) on first presentation to the hospital. After adjusting of age and gender the prevalence of any white cell abnormality was 34.7% (290/835) (5.7% leukopenia, 9.6% leucocytosis, 25.4% lymphopenia, 5.5% neutropenia, 16.4% had neutrophilia, 7.3% monocytosis, and 1.2% eosinopenia). A prevalence of 15.3% (128/835) anaemia, 9.5% (79/835) thrombocytopenia and 4.3% (36/ 835) thrombocytosis was also observed. The prevalence of other abnormal blood parameters: C reactive protein 69.5%(573/835), D dimer 57.5% (280/835), high LDH 52%(383/835), high ferritin 72.1%(452/835), high INR 5.1%(38/835), prolonged PT 32.2% (240/835), and prolonged APTT 35.6%(264/835). A significant difference in prevalence of these abnormalities was evident between adult and Paediatric population, these abnormalities were much more prevalent in adults but interestingly paediatric population tended to have higher incidence of neutropenia, eosinophilia and monocytosis (p<0.001). Conclusion: The effects of COVID 19 infection are different in adult and paediatric patients. Many mechanisms have been hypothesized for this observation. This study revealed another less studied and interesting variation in the manifestation among the two populations.

Veno-venous extra-corporeal membrane oxygenation in a COVID-19 patient with cold-agglutinin haemolytic anaemia: A case report.

OVERVIEW: The use of extra-corporeal membrane oxygenation (ECMO) therapy to treat severe COVID-19 patients with acute respiratory failure is increasing worldwide. We reported herein the use of veno-venous ECMO in a patient with cold agglutinin haemolytic anaemia (CAHA) who suffered from severe COVID-19 infection. DESCRIPTION: A 64-year-old man presented to the emergency department (ED) with incremental complaints of dyspnoea and cough since one week. His history consisted of CAHA, which responded well to corticosteroid treatment. Because of severe hypoxemia, urgent intubation and mechanical ventilation were necessary. Despite deep sedation, muscle paralysis and prone ventilation, P/F ratio remained low. Though his history of CAHA, he still was considered for VV-ECMO. As lab results pointed to recurrence of CAHA, corticosteroids and rituximab were started. The VV-ECMO run was short and rather uncomplicated. Although, despite treatment, CAHA persisted and caused important complications of intestinal ischemia, which needed multiple surgical interventions. Finally, the patient suffered from progressive liver failure, thought to be secondary to ischemic cholangitis. One month after admission, therapy was stopped and patient passed away. CONCLUSION: Our case report shows that CAHA is no contraindication for VV-ECMO, even when both titre and thermal amplitude are high. Although, the aetiology of CAHA and its response to therapy will determine the final outcome of those patients.