Covid-19 pneumonia in sickle cell anemia: A case report

ABSTRACT

Introduction Chronic medical illnesses can increase complications among patients with COVID19 infection. Sickle cell anemia is a chronic illness primarily found in persons of African descent, and COVID-19 has been found to disproportionately affect African Americans. However, there is scant data on the cohort of patients in which COVID-19 and Sickle cell anemia co-exist. Herein, we outline the hospital course of a 62-yearold woman with Hemoglobin (Hb) SS and COVID-19 infection. Case Presentation A 62-year-old woman with a history of Hemoglobin (Hb) SS complicated by avascular necrosis of the left shoulder presented to the emergency department with worsening shortness of breath for two days. She endorsed fevers, chills, cough, diarrhea and back pain similar to her sickle cell pain crises. She also revealed that she had tested positive for COVID-19 a week prior to presentation, after being exposed to a family member who was infected. On presentation, she was afebrile and normotensive but tachycardic, tachypneic, with initial oxygen saturation in the 70's which improved to 95-100% with high flow nasal canula (HFNC) 50% FiO2, 50 liters per minute. Initial labs revealed severe anemia (Hb 3.9, baseline 6.0), acute kidney injury, lactic acidosis, indirect hyperbilirubinemia, and elevated LDH. Chest X-ray showed bilateral multifocal consolidations. She was admitted to the medical intensive care unit for management of acute hypoxemic respiratory failure due to COVID pneumonia and acute chest syndrome. She received intravenous remdesivir, dexamethasone, ceftriaxone, and azithromycin. She underwent simple blood transfusion of 3 units packed red blood cells (PRBC), then a therapeutic RBC exchange transfusion. She was also on intravenous heparin, intravenous fluids and opioids. She was consented and enrolled in a lenzilumab trial. The patient clinically improved and was transferred to the intermediate care unit. Her supplementary oxygen was weaned down from HFNC to two liters per minute via nasal cannula. She was discharged with home oxygen, as well as outpatient follow up with sickle cell and primary care clinics. Discussion COVID-19 should be recognized as a new viral pathogen for acute chest syndrome. This patient had sickle cell pain, and COVID-19 screening should be considered among those presenting with painful crises during this pandemic to avoid overlooking a possible inciting factor. Exchange transfusion was utilized in this case;further case studies and clinical trials would aid clinicians in understanding appropriate management when these illnesses co-exist.