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1.
J Med Case Rep ; 15(1): 606, 2021 Dec 13.
Article in English | MEDLINE | ID: covidwho-1571931

ABSTRACT

BACKGROUND: In this report, we describe a very challenging case of a patient with secondary Evans syndrome caused by severe coronavirus disease 2019 infection in a pregnant full-term woman. CASE PRESENTATION: A 29-year-old full-term pregnant Indonesian woman presented with gross hematuria, dry cough, fever, dyspnea, nausea, anosmia, and fatigue 5 days after confirmation of coronavirus disease 2019 infection. Laboratory examinations showed very severe thrombocytopenia, increased indirect bilirubin, and a positive direct Coombs' test. From peripheral blood, there was an increased number of spherocytes, which indicated an autoimmune hemolytic process. Antinuclear antibody and anti-double-stranded DNA test results were negative, and her virology serological markers are also negative for human immunodeficiency virus, cytomegalovirus, and hepatitis B and C. Despite aggressive treatment with platelet transfusion, high-dose steroid, and thrombopoietin receptor agonists, the platelet count did not recover, and a speculative cesarean delivery had to be done with a very low platelet count.


Subject(s)
COVID-19 , Thrombocytopenia , Adult , Anemia, Hemolytic, Autoimmune , Female , Humans , Pregnancy , Pregnant Women , SARS-CoV-2 , Thrombocytopenia/etiology
2.
Rinsho Ketsueki ; 62(10): 1510-1514, 2021.
Article in Japanese | MEDLINE | ID: covidwho-1502774

ABSTRACT

A 75-year-old woman with a history of postoperative chemotherapy for lung adenocarcinoma and a history of Helicobacter pylori eradication for idiopathic thrombocytopenic purpura (ITP) was admitted to the department of hematology and oncology for the treatment of anemia 2 weeks after BNT162b2 mRNA COVID-19 vaccination. Her blood examination revealed direct and indirect Coombs test-positive hemolytic anemia and elevation of serum LDH and indirect bilirubin levels. No obvious trigger other than BNT162b2 mRNA COVID-19 vaccination was found. She was diagnosed with autoimmune hemolytic anemia (AIHA), and oral prednisolone therapy was administered. The anemia improved soon after the administration of prednisolone. Although vaccination is considered to be very important for suppressing the spread of COVID-19, there have been reports of increasing risk of ITP development and deterioration caused by BNT162b2 mRNA COVID-19 vaccination. Because the number of vaccinated people is increasing rapidly, hematologists must be vigilant to the development of AIHA after BNT162b2 mRNA COVID-19 vaccination although case reports of this phenomenon have been very rare thus far.


Subject(s)
Anemia, Hemolytic, Autoimmune , COVID-19 , Aged , COVID-19 Vaccines , Female , Humans , RNA, Messenger , SARS-CoV-2 , Vaccination
4.
Transfusion ; 61(11): 3267-3271, 2021 11.
Article in English | MEDLINE | ID: covidwho-1434847

ABSTRACT

BACKGROUND: Large clinical trials have demonstrated the overall safety of vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, reports have emerged of autoimmune phenomena, including vaccine-associated myocarditis, immune thrombocytopenia, and immune thrombotic thrombocytopenia. CASE PRESENTATION: Here we present a novel case of a young woman who developed life-threatening autoimmune hemolytic anemia (AIHA) after her first dose of a SARS-CoV-2 mRNA vaccine. Notably, initial direct antiglobulin testing was negative using standard anti-IgG reagents, which are "blind" to certain immunoglobulin (IgG) isotypes. Further testing using an antiglobulin reagent that detects all IgG isotypes was strongly positive and confirmed the diagnosis of AIHA. The patient required transfusion with 13 units of red blood cells, as well as treatment with corticosteroids, rituximab, mycophenolate mofetil, and immune globulin. CONCLUSION: As efforts to administer SARS-CoV-2 vaccines continue globally, clinicians must be aware of potential autoimmune sequelae of these therapies.


Subject(s)
Anemia, Hemolytic, Autoimmune/chemically induced , Anemia, Hemolytic, Autoimmune/therapy , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , SARS-CoV-2 , Adrenal Cortex Hormones/administration & dosage , Adult , Anemia, Hemolytic, Autoimmune/blood , Autoantibodies/blood , COVID-19/blood , COVID-19 Vaccines/administration & dosage , Erythrocyte Transfusion , Female , Humans , Immunoglobulin G/blood , Immunoglobulins/administration & dosage , Mycophenolic Acid/administration & dosage , Rituximab/administration & dosage
8.
BMJ Case Rep ; 14(7)2021 Jul 26.
Article in English | MEDLINE | ID: covidwho-1327626

ABSTRACT

A 70-year-old man with known cold autoimmune haemolytic anaemia was referred to the emergency department with increased shortness of breath on exertion. He had been confirmed positive for non-variant COVID-19 infection 1 week earlier based on nasopharyngeal swab PCR assay. CT thorax demonstrated diffuse patchy bilateral ground glass opacities, consistent with COVID-19 pneumonia. Bloodwork demonstrated severe cold agglutinin mediated haemolytic anaemia. To help stabilise the patient, he was transferred to a tertiary care hospital for urgent therapeutic plasma exchange. Key supportive therapy included folic acid supplementation, ensuring the patient was kept warm and warmed infusions including transfusions via the apheresis machine. The patient made a good recovery following plasma exchange, and his haemoglobin levels remained stable by discharge.


Subject(s)
Anemia, Hemolytic, Autoimmune , COVID-19 , Aged , Anemia, Hemolytic, Autoimmune/therapy , Dyspnea , Humans , Male , Plasma Exchange , SARS-CoV-2
11.
Neurol Sci ; 42(10): 4293-4296, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1226223

ABSTRACT

INTRODUCTION: Sars-CoV-2 is a single-strained RNA virus belonging to Coronaviridae's family. In pediatric age, the majority of patients is asymptomatic; however, several neurological manifestations associated with Sars-CoV-2 infection have been detected in a percentage of cases ranging from 17.3 to 36.4%. Acute disseminated encephalomyelitis (ADEM) has been recently included among the potential complications of Sars-Cov2 infection. The available data regarding pediatric patient show only one case. CASE REPORT: We present a case regarding a 6-year-old patient suffering from Fisher-Evans syndrome who was given sirolimus and thalidomide therapy. After 10 days since the first positive nasopharyngeal swab for Sars-CoV-2, in which he had no symptoms, he presented an episode of generalized tonic-clonic seizure with spontaneous resolution. The patient underwent MRI which showed the typical picture of acute disseminated encephalomyelitis. His clinical course was favorable, with a good response to cortisone therapy and a progressive improvement of the neuroradiological and electroencephalographic picture. CONCLUSIONS: According to our knowledge, this is the second case of an acute disseminated encephalomyelitis following SARS-CoV-2 infection in a pediatric patient, characterized by monosymptomatic onset, in which the immunosuppressive therapy practiced for the Fisher-Evans syndrome has probably contributed to a favorable evolution of ADEM, in contrast to other case described in the literature.


Subject(s)
COVID-19 , Encephalomyelitis, Acute Disseminated , Anemia, Hemolytic, Autoimmune , Child , Encephalomyelitis, Acute Disseminated/diagnostic imaging , Encephalomyelitis, Acute Disseminated/drug therapy , Encephalomyelitis, Acute Disseminated/etiology , Humans , Male , RNA, Viral , SARS-CoV-2 , Thrombocytopenia
15.
Hematology ; 26(1): 225-239, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1087620

ABSTRACT

OBJECTIVE: As COVID-19 is a new emerging disease, the hematological/immunological changes that develop in the infected patients remain unknown. This study aims to systematically review the hematologic autoimmune complications in these patients. METHOD: Data from three online databases including Medline (via PubMed), Scopus and Web of Science were searched on 19 December 2020, and after excluding duplicate, irrelevant and inappropriate records, eligible documents were identified. Afterwards, information such as patients' history, presentations, paraclinical data, treatment course and outcome were extracted from the records. RESULTS: A total of 58 documents were considered to be eligible for data extraction which described 94 patients with COVID-19 who developed hematologic autoimmune disorder in their course of infection. Of these patients with COVID-19, the most common hematologic autoimmune disorder was immune thrombocytopenic purpura (55 cases) followed by autoimmune hemolytic anemia (22 cases). Other hematologic autoimmune disorders include antiphospholipid syndrome, thrombotic thrombocytopenic purpura, Evans syndrome and autoimmune neutropenia. CONCLUSION: The current study would help us to always consider an autoimmune etiology for cases with abnormal hematologic finding which further lead to an appropriate treatment of the patients, especially when the symptoms present in about 1-2 weeks after the first manifestation of the infection symptoms. Maybe, at least in this pandemic, it should be recommended to evaluate patients with unexpected and unexplained decrease in their hemoglobulin or platelet count for COVID-19. Another challenging issue is the treatment options. Given the multiorgan involvement and multifaceted nature of the infection, an individualized approach should be taken for each patient.


Subject(s)
Autoimmune Diseases/etiology , COVID-19/complications , Hematologic Diseases/etiology , Anemia, Hemolytic, Autoimmune/blood , Anemia, Hemolytic, Autoimmune/etiology , Antiphospholipid Syndrome/blood , Antiphospholipid Syndrome/etiology , Autoimmune Diseases/blood , COVID-19/blood , Hematologic Diseases/blood , Humans , Neutropenia/blood , Neutropenia/etiology , Purpura, Thrombocytopenic, Idiopathic/blood , Purpura, Thrombocytopenic, Idiopathic/etiology , Purpura, Thrombotic Thrombocytopenic/blood , Purpura, Thrombotic Thrombocytopenic/etiology , SARS-CoV-2/isolation & purification , Thrombocytopenia/blood , Thrombocytopenia/etiology
16.
Front Immunol ; 11: 609198, 2020.
Article in English | MEDLINE | ID: covidwho-1080669

ABSTRACT

During COVID-19 pandemic the care of onco-hematologic and autoimmune patients has raised the question whether they are at higher risk of infection and/or worse outcome. Here, we describe the clinical course of COVID-19 pneumonia in patients with autoimmune cytopenias (AIC) regularly followed at a reference center in Northern Italy. The study period started from COVID-19 outbreak (February 22, 2020) until the time of writing. Moreover, we provide a review of the literature, showing that most cases reported so far are AIC developed during or secondary to COVID-19 infection. At variance, data about AIC pre-existing to COVID infection are scanty. The 4 patients here described (2 autoimmune hemolytic anemias, AIHA, 1 Evans syndrome, and 1 immune thrombocytopenia) with COVID-19 pneumonia belong to a large cohort of 500 AIC patients, making this study nearly population-based. The observed frequency (4/501; 0.7%) is only slightly superior to that of the general population admitted to hospital/intensive care unit (0.28/0.03%, respectively) in Lombardy in the same period of observation. All cases occurred between March 21 and 25, whilst no more AIC were recorded later on. Although different in intensity of care needed, all patients recovered from COVID-19 pneumonia, with apparently no detrimental effect of previous/current immunomodulatory treatments. AIHA relapse occurred in two patients, but promptly responded to therapy. With limitations due to sample size, these results suggest a favorable outcome and a lower-than-expected incidence of COVID-19 pneumonia in patients with previously diagnosed AIC, and allow speculating that immunomodulatory drugs used for AIC may play a beneficial rather than a harmful effect on COVID-19 infection.


Subject(s)
Anemia, Hemolytic, Autoimmune/complications , COVID-19/epidemiology , Pneumonia, Viral/epidemiology , Purpura, Thrombocytopenic, Idiopathic/complications , Aged , Aged, 80 and over , Female , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Pneumonia, Viral/virology , SARS-CoV-2 , Young Adult
19.
J Med Case Rep ; 14(1): 246, 2020 Dec 18.
Article in English | MEDLINE | ID: covidwho-992552

ABSTRACT

BACKGROUND: In December 2019, a new coronavirus (named severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) spread from China, causing a pandemic in a very short time. The main clinical presentation of SARS-CoV-2 infection (COVID-19, coronavirus disease-2019) is pneumonia, but several cardiovascular complications may also occur (e.g., acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure and cardiogenic shock). Direct or indirect mechanisms induced by SARS-CoV-2 could be implicated in the pathogenesis of these events. CASE PRESENTATION: We report herein the third case of COVID-19 autoimmune haemolytic anaemia (AIHA) reported so far, which occurredwithout any other possible explanations in a Caucasian patient. The patient also suffered from ST-elevation myocardial injury. CONCLUSIONS: Both complications occurred quite late after COVID-19 diagnosis and were probably precipitated by systemic inflammation, as indicated by a significant delayed increase in inflammatory markers, including interleukin-6 (IL-6).


Subject(s)
Anemia, Hemolytic, Autoimmune/blood , Asymptomatic Infections , C-Reactive Protein/immunology , COVID-19/blood , Interleukin-6/immunology , ST Elevation Myocardial Infarction/diagnosis , Aged, 80 and over , Anemia, Hemolytic, Autoimmune/drug therapy , Anemia, Hemolytic, Autoimmune/etiology , Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19/complications , COVID-19/drug therapy , COVID-19/immunology , Coombs Test , Electrocardiography , Enzyme Inhibitors/therapeutic use , Female , Glucocorticoids/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Prednisolone/therapeutic use , SARS-CoV-2 , ST Elevation Myocardial Infarction/drug therapy , ST Elevation Myocardial Infarction/etiology
20.
BMJ Case Rep ; 13(12)2020 Dec 10.
Article in English | MEDLINE | ID: covidwho-971917

ABSTRACT

A man in his early 50s presented with jaundice, mild shortness of breath on exertion and dark urine. He had had coryzal symptoms 2 weeks prior to admission. Medical history included obstructive sleep apnoea and hypertension. His initial blood tests showed a mild hyperbilirubinaemia and acute kidney injury stage 1. Chest X-ray and CT pulmonary angiogram were negative for features suggestive of COVID-19. He later developed a drop in haemoglobin and repeat bloods showed markedly raised lactate dehydrogenase and positive direct antiglobulin test. These results were felt to be consistent with a haemolytic anaemia. A nasopharyngeal swab came back positive for COVID-19. We suspect the cause of his symptoms was an autoimmune haemolytic anaemia secondary to COVID-19 which has recently been described in European cohorts.


Subject(s)
Anemia, Hemolytic, Autoimmune/diagnosis , Anemia, Hemolytic, Autoimmune/etiology , COVID-19 Testing , COVID-19/diagnosis , COVID-19/complications , Chest Pain/etiology , Hemoglobinuria/etiology , Humans , Jaundice/etiology , Male , Middle Aged
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