Autoimmune Hemolytic Anemia as a Novel Complication of COVID-19 Infection in Sanglah General Hospital Bali, Indonesia
DOI:
https://doi.org/10.3889/oamjms.2020.5484Keywords:
Autoimmune hemolytic anemia, Coronavirus disease-19, CorticosteroidAbstract
BACKGROUND: Clinical manifestation of coronavirus disease (COVID-19) could be asymptomatic, mild to severe, even mortality. Although various hematological complications associated with COVID-19 infection have been reported, the finding of autoimmune hemolytic anemia (AIHA) is a novel case.
CASE REPORT: A 59-year-old woman was admitted to our emergency room because of a 5-day period of fever with cough and shortness of breath. At admission, she was takipnea, jaundice, and had an oxygen saturation of 60% on room air. Laboratory studies showed hemoglobin (Hb) 3.68 g/dL, high reticulocyte (14.4%), and hyperbilirubinemia. Chest X-ray showed bilateral pneumonia with positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test. Although she got packed red cell (PRC) transfusions in 7 days, her Hb remained low and bilateral infiltrate still increased. That’s why we considered direct Coombs test and it returned positive. AIHA was diagnosed and treatment with hydrocortisone 100 mg IV twice daily was given for the first 72 h. The maintenance dose with methylprednisolone 16 mg twice daily was continued for 7 days admission. Then, Hb value increased to 11.03 g/dL and she was discharged home without any compliments.
CONCLUSION: In the current epidemiological situation, AIHA needs to be considered as a complication of COVID-19 infection in a patient who presents with jaundice and severe anemia without any underlying chronic disease, which is need blood transfusions, steroid medication use, or blood cancer.
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Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for disease control and prevention. JAMA. 2020;323(13):1239-42. https://doi.org/10.1001/jama.2020.2648 PMid:32091533 DOI: https://doi.org/10.1001/jama.2020.2648
Kementerian Kesehatan Republik Indonesia. Info Infeksi Emerging Kementerian Kesehatan RI Update Hingga. Indonesia: Kementerian Kesehatan Republik Indonesia; 2020. Available from: https://covid19.kemkes.go.id/category/situasi-infeksi-emerging/info-corona-virus/#.X6dwjvkzbIU, 20 August 2020.
Susilo A. Tim penanganan kasus pasien dengan penyakit infeksi new emerging dan re-emerging disease (PINERE) RSUPN Dr. Cipto mangunkusumo. Coronavirus disease 2019: Review of current literature. J Penyakit Dalam Indones. 2020;7(1):433. https://doi.org/10.7454/jpdi.v7i2.433 DOI: https://doi.org/10.7454/jpdi.v7i2.433
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506. DOI: https://doi.org/10.1016/S0140-6736(20)30183-5
Longo DL, Kasper Dl, Jameson JL, Fauci AS, Hauser SL, Loscalzo J. Harrison’s Principles of Internal Medicine. 18th ed. United States: McGraw-Hill; 2012. https://doi.org/10.1111/j.1445-5994.2008.01837.x DOI: https://doi.org/10.1111/j.1445-5994.2008.01837.x
Sudoyo AW, Setiyohadi B, Alwi I, Simadibrata M, Penyunting SS. Buku Ajar Ilmu Penyakit Dalam. Jakarta: Interna Publishing; 2009. p. 1162.
Hill QA, Stamps R, Massey E, Grainger JD, Provan D, Provan D, et al. The diagnosis and management of primary autoimmune haemolytic anaemia. Br J Haematol. 2017;176(3):395-411. https://doi.org/10.1111/bjh.14478 PMid:28005293 DOI: https://doi.org/10.1111/bjh.14478
Liu W, Li H. COVID-19: Attacks the 1-beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism. China: Sichuan University of Science and Engineering; 2020. https://doi.org/10.26434/chemrxiv.12120912 DOI: https://doi.org/10.26434/chemrxiv.12120912
Angileri F, Legare S, Gammazza AM, Macario EC, Macario AJL, Cappello F. Is molecular mimicry the culprit in the autoimmune haemolytic anaemia affecting patients with COVID-19? Br J Haemotol. 2020;190(2):e92-3. https://doi.org/10.1111/bjh.16883 PMid:32453861 DOI: https://doi.org/10.1111/bjh.16883
World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Geneva: World Health Organization; 2020.
Lazarian G, Quinquenel A, Bellal M, Siavellis J. Autoimmune haemolytic anaemia associated with Covid-19 infection. 2020. Br J Haematol. 2020;190(1):29-31. PMid:32374906 DOI: https://doi.org/10.1111/bjh.16794
Jager U, Barcellini W, Broome C, Gertz MA, Hill A, Hill QA. Diagnosis and treatment of autoimmune hemolytic anemia in adults: Recommendsations from the first international consensus meeting. Blood Rev. 2020;41:1006-48 https://doi.org/10.1016/j.blre.2019.100648 PMid:31839434 DOI: https://doi.org/10.1016/j.blre.2019.100648
Rezk NA, Ibrahim AM. Effects of methyl prednisolone in early ARDS. Egyp J Chest Dis Tuberc. 2013;62:167-72. https://doi.org/10.1016/j.ejcdt.2013.02.013 DOI: https://doi.org/10.1016/j.ejcdt.2013.02.013
Lee N, Chan A, Hui D, Enders KO, Wu A, Chiu R. Effects of early corticosteroid treatment on plasma SARS-associated coronavirus RNA concentrations in adult patients. J Clin Virol. 2004;31(4):304-9. https://doi.org/10.1016/j.jcv.2004.07.006 PMid:15494274 DOI: https://doi.org/10.1016/j.jcv.2004.07.006
Fang X, Mei Q, Yang T, Li L, Wang Y, Tong F. Low-dose corticosteroid therapy does not delay viral clearance in patients with COVID-19. J Infect. 2020;80(1):147-178. https://doi.org/10.1016/j.jinf.2020.03.039 PMid:32283153 DOI: https://doi.org/10.1016/j.jinf.2020.03.039
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Copyright (c) 2020 I. Putu Surya Sujana, Ni Putu Ayu Widiasari, Ni Luh Putu Eka Arisanti, Ida Bagus Ngurah Rai, Ni Made Renny Anggreni Rena (Author)
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