Hemolysis in COVID 19 Positive Patients: 2 Case Reports

ABSTRACT

Introduction: The presentation of SARS-CoV-2 (COVID 19) isvaried. Although, respiratory system is predominantly affected, AIHAboth warm and cold antibody types have also been reported in somepatients. We worked up 2 such patients who presented to us withCOVID symptoms along with unexplained hemolysis. The 1st patientpresented with mucormycosis and was on Amphotericin B. Bothpatients had history of blood transfusion. The 2nd patient on examination was found to have generalized lymphadenopathy. Peripheralsmear of 1st patient showed morphological features of hemolysis. Theother patient showed agglutination on peripheral smear that resolvedon preheating of sample before smear formation. On further workup,both showed Direct Agglutination Test (DAT) positivity with presence of autoantibodies as well as alloantibodies.Aims &Objectives: To workup and establish the cause of hemolysisin COVID positive patients.Materials &Methods: Routine complete blood count and peripheralsmear studies were performed for these patients along with relevantbiochemical tests. Samples were subjected to DAT and antibodyscreening. Both 3 cell and 11 cell panel testing was done by gel cardmethod (Bio Rad).Result: DAT was positive in both the cases, with IgG positivity in 1stcase, indicative of warm antibodies. 2nd case showed presence ofmixed antibodies with IgG, IgA, C3d, IgM and C3c positivity. Onextended antibody panel testing, 2-3 + reactivity was seen in bothcases in the whole panel with auto control positivity, indicative ofpresence of both auto and alloantibodies.Conclusions: Although immune mediated hemolysis in COVIDpatients is not uncommon, it should be labelled as the cause only afterall other common causes have been thoroughly looked into and ruledout.