Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 25
Filter
1.
Hematology ; 27(1): 1191-1195, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2087622

ABSTRACT

OBJECTIVE: Various hematologic side effects of the Coronavirus Disease 2019 (COVID-19) vaccination has been reported, and most of them are thought to be related to autoimmune pathways. To the best of our knowledge, only few cases of post-COVID-19 vaccination aplastic anemia (AA) have been reported and there is no reported Korean case of COVID-19 vaccine-induced AA yet. We present a case of severe immune-mediated AA that developed after the administration of a messenger ribonucleic acid (mRNA) gene-based spike protein vaccine against COVID-19, which responded well to immunosuppressive therapy, and discuss the probable pathogenesis of AA and the implication of vaccination along with a comparison of previous cases reported. METHODS: A 53-year-old Korean man developed sudden pancytopenia three months after COVID-19 vaccination. To evaluate the cause of pancytopenia, a bone marrow study was performed. RESULTS: A diagnosis of AA was made through the bone marrow study and he received triple immunosuppressive therapy (IST). After triple IST for five months, his blood cell count was improved and maintained without transfusion and his follow-up bone marrow examination showed improved cellularity. CONCLUSION: COVID-19 vaccine might be associated with the development of immune-mediated AA. Prompt hematologic evaluation should be performed when there are symptoms or signs suggestive of cytopenia after COVID-19 vaccination. Although the clinical outcome of post-vaccination AA varies, a good prognosis can be possible for patients with COVID-19 vaccination-induced AA.


Subject(s)
Anemia, Aplastic , COVID-19 Vaccines , COVID-19 , Pancytopenia , Humans , Male , Middle Aged , Anemia, Aplastic/drug therapy , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Immunosuppression Therapy/adverse effects , Immunosuppressive Agents/adverse effects , Pancytopenia/chemically induced , RNA, Messenger , Vaccination/adverse effects
2.
Am J Case Rep ; 23: e937500, 2022 Sep 24.
Article in English | MEDLINE | ID: covidwho-2056389

ABSTRACT

BACKGROUND Diffuse large B cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL). While bone marrow (BM) involvement is common in lymphoma, primary bone marrow (PBM) DLBCL is extremely rare. We present a case of PBM DLBCL discovered in a patient with COVID-19. CASE REPORT An 80-year-old man presented with generalized abdominal pain, weight loss, fever, fatigue, anorexia, and watery diarrhea over a 3-month period. Physical examination was unremarkable. Laboratory workup revealed anemia, thrombocytopenia, and elevated inflammation markers. SARS-COV-2 PCR was positive, while blood cultures were negative. A rapid decline in the white blood cell count in the following days prompted a BM biopsy, confirming the diagnosis of PBM DLBCL. Computed tomography (CT) did not show thoracic or abdominal lymphadenopathy. The patient received packed red blood cell and platelet transfusions, granulocyte colony-stimulating factor (G-CSF) for pancytopenia, and empirical antibiotics for suspected infection. Due to active COVID-19 and advanced age, cytotoxic chemotherapy was delayed. Rituximab and prednisone were initiated on day 9, followed by an infusion reaction, which led to treatment discontinuation. He died 2 days later. CONCLUSIONS Diagnosing PBM malignancy is challenging, especially with coexisting infection. It is essential to suspect underlying BM malignancy in patients with clinical deterioration and worsening pancytopenia despite adequate treatment. The diagnosis of PBM DLBCL requires the absence of lymphadenopathy, and the presence of histologically confirmed DLBCL. Prompt management with combination chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) with/without hematopoietic stem cell transplant can improve the prognosis.


Subject(s)
COVID-19 , Lymphadenopathy , Lymphoma, Large B-Cell, Diffuse , Pancytopenia , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Marrow/pathology , COVID-19/complications , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Lymphadenopathy/pathology , Lymphoma, Large B-Cell, Diffuse/complications , Lymphoma, Large B-Cell, Diffuse/diagnosis , Lymphoma, Large B-Cell, Diffuse/therapy , Male , Pancytopenia/etiology , Prednisone/therapeutic use , Rituximab/therapeutic use , SARS-CoV-2 , Vincristine/therapeutic use
3.
Medicina (Kaunas) ; 58(9)2022 Sep 15.
Article in English | MEDLINE | ID: covidwho-2043856

ABSTRACT

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.


Subject(s)
Anemia, Aplastic , COVID-19 , Hemoglobinuria, Paroxysmal , Pancytopenia , Aged , Anemia, Aplastic/complications , Anemia, Aplastic/diagnosis , Anemia, Aplastic/genetics , COVID-19/complications , Female , Glycosylphosphatidylinositols , Hemoglobinuria, Paroxysmal/complications , Hemoglobinuria, Paroxysmal/diagnosis , Humans , Pancytopenia/complications , SARS-CoV-2
4.
BMC Infect Dis ; 22(1): 682, 2022 Aug 09.
Article in English | MEDLINE | ID: covidwho-1978762

ABSTRACT

BACKGROUND: Immunization against the coronavirus disease 2019 (COVID-19) began in January 2021 in Iran; nonetheless, due to a lack of vaccination among children under 12, this age group is still at risk of SARS-CoV-2 infection and its complications. CASE PRESENTATION: SARS-CoV-2 infection was diagnosed in a 6-year-old girl who had previously been healthy but had developed a fever and pancytopenia. The bone marrow aspiration/biopsy demonstrated just hypocellular marrow without signs of leukemia. She was worked up for primary and secondary causes of pancytopenia. Except for a repeated reactive HIV antibody/Ag P24 assay, all test results were inconclusive. After a thorough diagnostic investigation, the cross-reactivity of the HIV antibody/Ag P24 test with SARS-CoV-2 antibodies was confirmed. The patient did not develop any COVID-19-related signs and symptoms, but she did get a severe invasive fungal infection and neutropenic enterocolitis. She died as a result of disseminated intravascular coagulopathy. CONCLUSION: It is critical to recognize children infected with SARS-CoV-2 who exhibit atypical clinical manifestations of COVID-19, such as persistent pancytopenia. SARS-CoV-2 infection can cause severe and deadly consequences in children; thus, pediatricians should be aware of COVID-19's unusual signs and symptoms mimicking other conditions such as aplastic anemia.


Subject(s)
Anemia, Aplastic , COVID-19 , Enterocolitis, Neutropenic , HIV Infections , Invasive Fungal Infections , Pancytopenia , Anemia, Aplastic/etiology , Bone Marrow/pathology , COVID-19/complications , Child , Enterocolitis, Neutropenic/complications , Female , HIV Infections/complications , Humans , Invasive Fungal Infections/complications , Pancytopenia/diagnosis , Pancytopenia/etiology , SARS-CoV-2
5.
Sci Rep ; 12(1): 7743, 2022 05 11.
Article in English | MEDLINE | ID: covidwho-1947429

ABSTRACT

Data concerning the efficacy of SARS-CoV-2 vaccines in patients with non-oncological hematologic conditions are lacking. These include autoimmune cytopenias (autoimmune hemolytic anemia AIHA, immune thrombocytopenia ITP, and autoimmune neutropenia), and bone marrow failure syndromes (aplastic anemia, low risk myelodysplastic syndromes, and paroxysmal nocturnal hemoglobinuria). These conditions may relapse/reactivate after COVID-19 infection and vaccine. Moreover, they are mainly handled with immunosuppressive drugs that may hamper the response to vaccine. In this study, we prospectively evaluated the rate of seroconversion after mRNA SARS-CoV-2 vaccines in patients with autoimmune cytopenias or bone marrow failure syndrome after 2 ± 1 months from the last vaccine dose. Overall, 149 patients were tested and 135 (91%) seroconverted. The highest proportion of non-responders was observed in Evans syndrome (association of ITP and AIHA) and warm AIHA patients (p = 0.001), in those with lower levels of baseline serum IgG (p = 0.008), and in patients on active therapy with steroids (p = 0.03) who also had lower anti-Spike titers. The latter were inversely related with age, and a positively with lymphocyte counts. Additionally, patients who had received rituximab within 12 months from vaccination showed higher rates of non-response (p = 0.03) as compared to those treated before. Contrarily, cyclosporine alone, complement inhibitors, and bone marrow stimulating agents had no detrimental effect on seroconversion. These data suggest maintaining high vigilance and adherence to preventive/protective measures in this population since a proportion of cases may not respond or exhibit low anti-Spike titers.


Subject(s)
COVID-19 , Pancytopenia , Purpura, Thrombocytopenic, Idiopathic , Vaccines , Bone Marrow Failure Disorders , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Humans , RNA, Messenger , SARS-CoV-2 , Seroconversion
6.
Tohoku J Exp Med ; 258(1): 63-68, 2022 Aug 10.
Article in English | MEDLINE | ID: covidwho-1938489

ABSTRACT

The detailed clinical course of coronavirus disease 2019 (COVID-19) in patients with hairy cell leukemia (HCL) is rarely reported. We report the first case of HCL diagnosed with prolonged pancytopenia after COVID-19 infection in Japan. We describe the case of a 56-year-old man who was diagnosed with COVID-19. Computed tomography revealed ground-glass opacities in the bilateral lung lobes as well as splenomegaly. Remdesivir and dexamethasone were administered for the treatment of COVID-19. Since the pancytopenia persisted, bone marrow examination was performed, and he was diagnosed with HCL. Although pancytopenia can occur with COVID-19 alone, clinicians should be alerted regarding the presence of hematologic malignancies in patients in whom pancytopenia persists after COVID-19 treatment or in those with splenomegaly. Further, the condition of all previously reported patients with COVID-19 associated with HCL was severe enough to require mechanical ventilation. This is the first case in which the disease was not severe. The interleukin-6 (IL-6) level was lower in this case than in previous cases, suggesting that racial differences in IL-6 production may have contributed to COVID-19 severity.


Subject(s)
COVID-19 , Coronavirus , Leukemia, Hairy Cell , Pancytopenia , COVID-19/complications , COVID-19/drug therapy , Humans , Interleukin-6 , Leukemia, Hairy Cell/complications , Leukemia, Hairy Cell/drug therapy , Leukemia, Hairy Cell/pathology , Male , Middle Aged , Pancytopenia/complications , Splenomegaly/complications , Splenomegaly/pathology
7.
Pediatrics ; 149(1)2022 01 01.
Article in English | MEDLINE | ID: covidwho-1595609

ABSTRACT

A 9-year-old girl presented to her primary care pediatrician via telemedicine during the initial months of the coronavirus disease 2019 pandemic because of 4 days of warmth perceived by her mother, decreased energy, and a new rash on her upper extremities. After 10 additional days of documented fever >38°C, worsening fatigue, and 1 day of nausea, vomiting, and diarrhea, she was allowed to schedule an in-person visit with her pediatrician after testing negative for severe acute respiratory syndrome coronavirus 2. She appeared ill on arrival to clinic, and her pediatrician recommended evaluation in an emergency department. Her initial laboratory testing revealed nonspecific elevation in several inflammatory markers and leukopenia, and she responded well to intravenous hydration. Over the next 2 weeks, her fever persisted, constitutional symptoms worsened, and she developed progressively painful cervical lymphadenopathy and pancytopenia. She was evaluated in clinic by several specialists and eventually was urged to present to the emergency department again, at which time she was admitted to the PICU. After consulting additional specialists and waiting for laboratory results, the team reached a definitive diagnosis and initiated therapy; however, she experienced rapid clinical decline shortly thereafter. The specialists who assisted with identification of the underlying etiology of her symptoms were able to work together to manage the subsequent complications.


Subject(s)
Exanthema , Fever , Intensive Care Units, Pediatric , Lupus Erythematosus, Systemic/diagnosis , Telemedicine , COVID-19/complications , COVID-19/diagnosis , Child , Disease Progression , Exanthema/diagnosis , Exanthema/etiology , Female , Fever/etiology , Histiocytic Necrotizing Lymphadenitis/diagnosis , Humans , Lupus Erythematosus, Systemic/blood , Lupus Erythematosus, Systemic/complications , Lymphadenopathy/diagnosis , Lymphadenopathy/etiology , Pancytopenia/diagnosis , Symptom Assessment , Systemic Inflammatory Response Syndrome/diagnosis
9.
BMJ Case Rep ; 14(8)2021 Aug 05.
Article in English | MEDLINE | ID: covidwho-1346042

ABSTRACT

A 40-year-old woman presented to our emergency department in an altered state following a generalised tonic-clonic seizure. On regaining consciousness, she gave a history of bleeding tendencies and menorrhagia, fatigue, nausea, vomiting and appetite loss for a long time. She had received multiple blood transfusions in the last 10 years. Investigations revealed severe hyponatraemia, transaminitis and pancytopenia, which showed cyclical fluctuations in the hospital. Hyponatraemia was attributed to a central cause owing to secondary hypothyroidism and hypocortisolism on evaluation. A diagnosis of cyclical thrombocytopenia was made by logging the trends of blood cell lines and applying the Lomb-Scargle test. Liver biopsy showed features of transfusion hemosiderosis explaining transaminitis. All of the haematological abnormalities and clinical symptoms resolved on thyroxine and corticosteroid replacement, suggesting causal association hypopituitarism with cyclical thrombocytopenia.


Subject(s)
Adrenal Insufficiency , Hyponatremia , Hypopituitarism , Pancytopenia , Adult , Female , Humans , Hyponatremia/diagnosis , Hyponatremia/etiology , Hypopituitarism/complications , Hypopituitarism/diagnosis , Hypopituitarism/drug therapy , Seizures
12.
BMJ Case Rep ; 14(3)2021 Mar 31.
Article in English | MEDLINE | ID: covidwho-1166386

ABSTRACT

Haemophagocytic lymphohistiocytosis (HLH) is a rare diagnosis that carries a high degree of mortality. We present this case of a previously healthy 22-year-old woman, who was admitted acutely ill to the hospital. One week prior, she had been seen by her primary care physician for fatigue and malaise. At that time, she was noted to have anterior and posterior cervical lymphadenopathy. She was referred to the emergency room and was diagnosed with acute Epstein-Barr virus (EBV) mononucleosis based on her clinical symptoms and positive heterophile antibody test. She was discharged after an uneventful 48-hour stay on the wards. She represented 7 days after discharge with cough, fatigue, nausea, vomiting, epigastric abdominal pain, diarrhoea, weight loss and subjective fevers. She had also reported haematemesis, epistaxis and melaena. Vital signs included temperature 36.9°C, blood pressure 90/50 mm Hg, heart rate 130 beats per minute and respiratory rate 32 breaths per minute. Physical examination was notable for an acutely ill appearing woman with scleral icterus, hepatosplenomegaly and palpable cervical and axillary lymphadenopathy. Complete blood count showed pancytopaenia with haemoglobin 59 g/L (normal 120-160 g/L), white blood cell count 2.7×109/L (normal 4-10.5×109/L) and platelet count 50×109/L (normal 150-450×109/L). The white blood cell count differential included 58% neutrophils (normal 38%-77%) with immature neutrophils in band form elevated at 45% (normal <14%), 16% lymphocytes (normal 20%-48%), 7% monocytes (normal <12%) and no eosinophils (normal <6%). Blood smear revealed anisocytosis, poikilocytosis and hypochromia. Coagulation panel showed elevated levels of d-dimer level at 1.39 µg/mL (normal <0.45 µg/mL), prolonged prothrombin time at 34.4 s (normal 11-15 s), prolonged activated partial thromboplastin time of 55.6 s (normal 25-34 s), prolonged international normalised ratio at 3.31 (normal <1.1) and low fibrinogen 60 mg/dL (normal >200 mg/dL). Lipid panel showed cholesterol at 114 mg/dL (normal 125-200 mg/dL), triglycerides 207 mg/dL (normal 30-150 mg/dL), high-density lipoprotein cholesterol 10 mg/dL (normal 40-60 mg/dL) and low-density lipoprotein cholesterol 63 mg/dL (normal <100 mg/dL). Other lab abnormalities included elevated ferritin of 6513 ng/mL (normal 10-150 ng/mL) and elevated lactate dehydrogenase of 1071 unit/L (normal 95-240 unit/L). Soluble interleukin-2 receptor alpha level was elevated at 60 727 units/mL (normal 223-710 units/mL). Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan showed abnormal tracer localisation within the paratracheal, hilar, pelvic, abdominal and subcarinal lymph nodes, along with FDG-PET positive hepatosplenomegaly. A bone marrow biopsy showed hypercellular marrow (95% cellularity) with trilineage haematopoiesis, haemophagocytic cells, polytypic plasmacytosis and T-cell lymphocytosis, along with positive latent membrane protein-1 immunohistochemical staining for EBV. EBV quantitative DNA PCR showed >1 million copies. These findings were consistent with a diagnosis of HLH secondary to EBV infection. Despite intense therapy with the HLH-94 protocol, the patient expired from her illness after a prolonged hospital course.


Subject(s)
Epstein-Barr Virus Infections , Infectious Mononucleosis , Lymphohistiocytosis, Hemophagocytic , Pancytopenia , Adult , Epstein-Barr Virus Infections/complications , Epstein-Barr Virus Infections/diagnosis , Female , Herpesvirus 4, Human , Humans , Lymphohistiocytosis, Hemophagocytic/complications , Lymphohistiocytosis, Hemophagocytic/diagnosis , Young Adult
13.
BMC Geriatr ; 21(1): 178, 2021 03 12.
Article in English | MEDLINE | ID: covidwho-1133582

ABSTRACT

BACKGROUND: Pancytopenia, fever, and elevated D-dimer are significant clinical findings. The differential diagnosis includes hematological malignancies, severe coronavirus disease 2019 (COVID-19), tick-borne illnesses, and other etiologies. CASE PRESENTATION: We report the case of a 95-year-old woman who presented with high fever (103.6 °F), pancytopenia, and markedly elevated D-dimer (32.21 mg/L; reference range ≤ 0.95 mg/L) in late-autumn during the COVID-19 pandemic at a large academic institution. After remaining persistently febrile, a peripheral blood smear was ordered and revealed parasites consistent with Ehrlichia spp. Doxycycline monotherapy led to symptomatic improvement and resolution of her pancytopenia. During her hospital stay, a computed tomography angiogram of the chest revealed pulmonary emboli, and esophagogastroduodenoscopy uncovered arteriovenous malformations. After appropriate treatment, she was discharged on hospital day 7 and has since done well. CONCLUSIONS: Overall, our case offers a dramatic, unexpected presentation of ehrlichiosis in a nonagenarian. To our knowledge, this is the first report of concurrent ehrlichiosis and pulmonary embolus.


Subject(s)
COVID-19 , Ehrlichiosis , Pancytopenia , Aged, 80 and over , Ehrlichiosis/diagnosis , Ehrlichiosis/drug therapy , Female , Fibrin Fibrinogen Degradation Products , Humans , Pancytopenia/diagnosis , Pancytopenia/etiology , Pandemics , SARS-CoV-2
14.
Am J Med Genet A ; 185(6): 1854-1857, 2021 06.
Article in English | MEDLINE | ID: covidwho-1121487

ABSTRACT

The COVID-19 pandemic has affected the health and healthcare of individuals of all ages worldwide. There have been multiple reports and reviews documenting a milder effect and decreased morbidity and mortality in the pediatric population, but there have only been a small number of reports discussing the SARS-CoV-2 infection in the setting of an inborn error of metabolism (IEM). Here, we report two patients with underlying metabolic disorders, propionic acidemia and glutaric aciduria type 1, and discuss their clinical presentation, as well as their infectious and metabolic management. Our report demonstrates that individuals with an underlying IEM are at risk of metabolic decompensation in the setting of a COVID-19 infection. The SARS-CoV-2 virus does not appear to cause a more severe metabolic deterioration than is typical.


Subject(s)
Amino Acid Metabolism, Inborn Errors/complications , Brain Diseases, Metabolic/complications , COVID-19/complications , Glutaryl-CoA Dehydrogenase/deficiency , Propionic Acidemia/complications , SARS-CoV-2 , Acidosis/etiology , Acidosis/therapy , Acidosis, Lactic/etiology , Blood Component Transfusion , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Combined Modality Therapy , Dietary Proteins/administration & dosage , Disease Management , Disease Susceptibility , Energy Intake , Enteral Nutrition , Female , Fluid Therapy , Glucose/administration & dosage , Glucose/adverse effects , Humans , Hyperammonemia/etiology , Hyperammonemia/therapy , Hyperglycemia/chemically induced , Hyperglycemia/drug therapy , Infant , Insulin/therapeutic use , Intensive Care Units, Pediatric , Oxygen Inhalation Therapy , Pancytopenia/etiology , Pancytopenia/therapy , Renal Dialysis , Systemic Inflammatory Response Syndrome/diagnosis
15.
Am J Emerg Med ; 45: 685.e1-685.e3, 2021 07.
Article in English | MEDLINE | ID: covidwho-1009248

ABSTRACT

Neutropenic enterocolitis is also known as typhlitis, is characterized by severe inflammation in the bowel loops. It is often seen in immunosuppressed patients, and it has high morbidity and mortality. Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system and causes COVID-19 (Coronavirus Disease 2019), it may affect hematopoietic and gastrointestinal systems. Herein, we present a rare case of COVID-19-associated pancytopenia and typhlitis in a 60-year-old female who presented with abdominal pain. Contrast-enhanced abdominal computed tomography (CT) demonstrated the bowel wall thickening in the cecum and ascending colon compatible with enterocolitis. Moreover, the chest CT showed bilateral, peripheral, and multifocal ground-glass opacities, consistent with COVID-19 pneumonia. We also aimed to emphasize the laboratory, clinical, and CT findings of the patient.


Subject(s)
COVID-19/complications , Colon/diagnostic imaging , Lung/diagnostic imaging , Pancytopenia/etiology , Tomography, X-Ray Computed/methods , Typhlitis/etiology , COVID-19/diagnosis , COVID-19/epidemiology , Female , Humans , Middle Aged , Pancytopenia/diagnosis , Pandemics , SARS-CoV-2 , Typhlitis/diagnosis
18.
Isr Med Assoc J ; 22(8): 505-513, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-972915

ABSTRACT

BACKGROUND: In this review we described the values of commonly available HScore laboratory markers in patients with coronavirus-19 (COVID-19)-pneumonia associated cytokine storm syndrome (CPN-CSS) and compared results with those of other forms cytokine storm syndrome (O-CSS) to determine a pattern for CPN-CSS. Twelve CPN-CSS studies and six O-CSS studies were included. CPN-CSS typically obtained a single HScore value (e.g., aspartate transaminase > 30 U/L) while failing all other HScore criteria. A typical pattern for CPN-CSS was revealed when compared to O-CSS: lymphopenia vs. pancytopenia and increased vs. decreased fibrinogen. Findings, other than HScore commonly found in CPN-CSS studies, showed elevated lactate dehydrogenase, D-dimer, and C-reactive protein. Although CPN-CSS studies describe severely ill patients, the HScore markers are typically less toxic that O-CSS.


Subject(s)
COVID-19/blood , COVID-19/complications , Cytokine Release Syndrome/blood , Cytokine Release Syndrome/etiology , Pneumonia/blood , Pneumonia/virology , Aspartate Aminotransferases/blood , C-Reactive Protein/metabolism , Ferritins/blood , Fibrin Fibrinogen Degradation Products/metabolism , Fibrinogen/metabolism , Humans , L-Lactate Dehydrogenase/blood , Lymphohistiocytosis, Hemophagocytic/blood , Lymphohistiocytosis, Hemophagocytic/complications , Lymphopenia/virology , Pancytopenia/etiology , Patient Acuity , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL