Autoimmune Hemolytic Anemia: A Late Presentation of Post-COVID-19 Syndrome

Abstract

COVID-19 is a severe respiratory disease with a spectrum of clinical presentations and complications. Warm autoimmune hemolytic anemia (WAIHA) is increasingly recognized in patients with COVID-19 either while infected or shortly after infection. We report a 36-year-old male with clinical and laboratory findings consistent with WAIHA. His medical history was significant for COVİD-19 infection three months before presentation. He was initially resistant to steroids but had substantial improvement following initiation of rituximab, with complete recovery thereafter. Therefore, serial assessment of complete blood cell count parameters and hemolysis markers post-COVID-19 infections is warranted for early detection and prompt treatment.

Late Respiratory and Laboratory Findings in Children with a History of Symptomatic and Asymptomatic SARS-CoV-2 Infection

“…Although hematological irregularities are known in acute COVID-19, abnormalities like autoimmune hemolytic anemia have also been reported in the late period. 17 In this study, no significant disorder was observed in terms of hematological parameters. Higher hemoglobin levels only in symptomatic patients can be explained by the higher prevalence of male patients in this group.…”

Autoimmune hemolytic anemia: a rare case report in a post-COVID patient

“…The warm AIHA is more common than cold AIHA, where IgG coated RBCs are removed by the reticuloendothelial macrophages and sequestered in the spleen, this sometimes would be the cause for splenomegaly. 3 The warm-AIHA is most commonly mediated through IgG reacting at ≥37ºC and cold AIHA is generally mediated through C3 component of complement. 5,8,9 Warm AIHA commonly has direct antibody test positive for IgG with or without complement-3, with the incidence for C3 only warm AIHA is less than 25%.…”

“…5 This is a rare case reported with a late onset after 4 weeks (one case presenting 3 months after infection is mentioned in literature). 3 The clinching diagnostic tests in this condition are direct anti-globulin test, peripheral smear with hemolytic changes and deranged retic counts. The positive direct Coombs test suggests an autoimmune pathology and normal C-reactive protein, D-dimer levels and negative RT-PCR for COVID-19 in our case suggest absence of active SARS-CoV-2 infection.…”

“…The association of COVID-19 with AIHA or as a secondary infection is a rare incidence. 2,3 The incidence of AIHA accounts to 1-3/100000 people per year worldwide with an average of 79 cases per year being reported from India, amongst which 52 are of primary etiology and 27 with secondary etiology of a the AIHA. Warm-AIHA is the most common type accounting for 80% of the adult cases and 50% of the pediatric cases.…”

“…Recent literatures have been come up with cases of secondary AIHA post COVID-19 wherein 31 cases of AIHA with acute SARS-CoV-2 are reported and one case reported with AIHA as a late COVID-19 syndrome. 2,3 There could be various extra-pulmonary complications seen as a SARS-CoV-2 sequelae like Gullian Barre syndrome, anti-phospholipid syndrome, or most common, multisystem inflammatory syndrome in children. Yet AIHA trigger due to past COVID-19 infection is very rare and here we are presenting one such case.…”