Hematologic Autoimmune Manifestation Secondary to Coronavirus Disease 19 Infection – A Single-Center Experience

Sanja Trajkova; Simona Stojanovska; Nevenka Ridova; Svetlana Krstevska-Balkanov; Aleksandra Pivkova-Veljanovska; Lidija Cevreska; Marija Popova-Labacevska; Irina Panovska-Stavridis

doi:10.3889/oamjms.2021.6766

Authors

Sanja Trajkova Department of Hematology, University Clinic for Hematology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia https://orcid.org/0000-0002-2877-2729
Simona Stojanovska Department of Hematology, University Clinic for Hematology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Nevenka Ridova Department of Hematology, University Clinic for Hematology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia https://orcid.org/0000-0002-0230-8266
Svetlana Krstevska-Balkanov Department of Hematology, University Clinic for Hematology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Aleksandra Pivkova-Veljanovska Department of Hematology, University Clinic for Hematology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Lidija Cevreska Department of Hematology, University Clinic for Hematology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Marija Popova-Labacevska Department of Hematology, University Clinic for Hematology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Irina Panovska-Stavridis Department of Hematology, University Clinic for Hematology, Medical Faculty, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia

DOI:

https://doi.org/10.3889/oamjms.2021.6766

Keywords:

Autoimmunity, Coronavirus disease 19, Corticosteroids, Hemolytic anemia, Thrombocytopenia

Abstract

Introduction: Since December 2019, multiple human cases of novel coronavirus infection were reported, representing with upper respiratory symptoms (influenza-like presentation). The virus was named the Severe acute respiratory system coronavirus 2 (SARS-COV-2). Studies have reported cases of patients with COVID-19 infection, including development of several autoimmune events that suggests that infection with SARS CoV-2 may be associated with initiation of autoimmune hematological autoimmune disorders.

Aim: Review the hematological autoimmune phenomenon after infection with SARS-COV-2 in order to assist into the pathogenic mechanisms, clinical manifestations and treatment of this group of patients.

Materials and methods: This is a retrospective study that includes 21 patients with autoimmune diseases like secondary immune thrombocytopenia (ITP), autoimmune hemolytic anemia( AIHA) and thrombotic thrombocytopenic purpura (TTP) that have emerged after COVID-19 infection. The patients were diagnosed and treated at the University Clinic of Hematology for a period of time from January 2020 to April 2021.

Results: The most common hematologic autoimmune disorder was ITP in 13 cases (62%) followed by AIHA in 5 cases (24%) and TTP in 3 individuals (14%). The mean time of onset of the hematologic auto-immune presentations was 18,4 ± 10,3 days. The therapy of this conditions in patients with COVID-19 infection requires an individualized approach to achieve a precise balance between the risk of severe bleeding and of thromboembolic events.

Conclusion: Causal relationship between COVID-19 infection and these autoimmune events still requires further studies. We should all have in mind the risk of development of hematologic autoimmune disorders in infected patients.

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