Clinical outcomes of children and adolescents with sickle cell disease and COVID-19 infection: A year in review at a metropolitan tertiary pediatric hospital

Abstract

BackgroundCOVID-19 was declared a global pandemic in March 2020. Early reports were primarily in adults, and sickle cell disease (SCD) was classified as a risk factor for severe COVID-19 disease. However, there are a limited number of primarily multi-center studies reporting on the clinical course of pediatric patients with SCD and COVID-19.MethodsWe conducted an observational study of all patients with SCD diagnosed with COVID-19 at our institution between March 31, 2020, and February 12, 2021. Demographic and clinical characteristics of this group were collected by retrospective chart review.ResultsA total of 55 patients were studied, including 38 children and 17 adolescents. Demographics, acute COVID-19 clinical presentation, respiratory support, laboratory findings, healthcare utilization, and SCD modifying therapies were comparable between the children and adolescents. Seventy-three percent (N = 40) of all patients required emergency department care or hospitalization. While 47% (N = 26) were hospitalized, only 5% (N = 3) of all patients required intensive care unit admission. Patients frequently had concurrent vaso-occlusive pain crisis (VOC) (N = 17, 43%) and acute chest syndrome (ACS) (N = 14, 35%). Those with ACS or an oxygen requirement had significantly higher white blood cell count, lower nadir hemoglobin, and higher D-dimers, supporting a pro-inflammatory and coagulopathic picture. Non-hospitalized patients were more likely to be on hydroxyurea than hospitalized patients (79 vs. 50%, p = 0.023).ConclusionChildren and adolescent patients with SCD and acute COVID-19 often present with ACS and VOC pain requiring hospital-level care. Hydroxyurea treatment appears to be protective. We observed no mortality despite variable morbidity.

Assessing the Impact of COVID-19 Vaccines on Sickle Cell Anaemia Patients: A Comparative Analysis of Biochemical and Haematological Parameters

“…Approximately, half of the participants were females (n = 45; 47.9% in the AstraZeneca group and n = 36; 55.4% in the Pfizer group). The average age was 29 years (23-38.25) in the AstraZeneca group, and 27 years (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) in the Pfizer group. The numbers of patients who showed post-vaccination side effects were only 5 (6.5%) and 9 (8.5%) for AstraZeneca and Pfizer groups, respectively.…”

“…SCD patients are at an increased risk of developing severe complications from COVID-19 infection due to their weakened immune system and underlying health conditions [ 21 ]. Recent studies have shown that individuals with SCD who contract COVID-19 are more likely to experience severe symptoms, require hospitalization, and they are at a higher mortality risk than the general population [ 22 , 23 ]. Previous studies have shown that adults with SCD usually have mild to moderate COVID-19 disease but are at higher risk of COVID-19-related hospitalization and death compared to adults without SCD [ 21 , 24 , 25 ].…”

The evolution of the COVID‐19 pandemic in paediatric patients with sickle cell disease: From Alpha to Omicron

“…During the initial phases of the pandemic, children with comorbidities were identified as at high risk for severe illness and hospitalization 2 . Our prior study of 55 sickle cell disease (SCD) COVID patients showed variable morbidity but no mortality 3 …”

“…2 Our prior study of 55 sickle cell disease (SCD) COVID patients showed variable morbidity but no mortality. 3 In mid-April 2020, the Alpha variant comprised approximately 66% of cases in the U.S. 4 The Delta variant rose to dominance in early July 2021, and was considered more contagious resulting in more severe illness in unvaccinated individuals. Omicron became the dominant variant in the U.S. in December 2021 and was classified as mild disease severity compared with other variants.…”