Concomitant autoimmune hemolytic anemia and pulmonary embolism associated with mild COVID‐19: A case report

Al-Mashdali, Abdulrahman F; Ata, Yaser M.; Yassin, Mohamed A

doi:10.1002/ccr3.4952

Cited by 3 publications

(4 citation statements)

References 16 publications

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“…In 27 (69,2%) out of the 39 cases identified in the literature, the patients, including the one described herein, had a full recovery from both COVID-19 and AIHA (28,(34)(35)(36)38,(40)(41)(42)(43)(44)46,47,(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59). Of note, 4 patients (10,2%) succumbed (26,39,45,54).…”

Section: Discussionmentioning

confidence: 71%

“…Due to laboratory limitations, the authors were not able to perform a titration of antiglobulin-Ab to determine whether the case was a CAD or wAIHA case, even though it is known that cold agglutinins are often a complication of specific infections and malignancies. In the literature search, a marked prevalence of CAD was observed, with 17 cases out of 39 being CAD (44%) (24,27,(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), 8 cases of wAIHA (20%) (28,(46)(47)(48), 2 cases of mAIHA (5%) (49,50) and 12 cases (31%) where titration was not performed (51)(52)(53)(54)(55)(56)(57)(58)(59).…”

Section: Discussionmentioning

confidence: 99%

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COVID‑19 infection and severe autoimmune haemolytic anaemia: A case report and review of the literature

Russotto,

Micali,

Marino

et al. 2023

World Acad Sci J

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During the ongoing coronavirus disease 2019 (COVID-19) pandemic, a number of autoimmune diseases have been found to be associated with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection, with thrombocytopenia being the most common. The present study describes the case of a female patient who tested positive for SARS-CoV-2 infection from samples from two nasopharyngeal swabs examined using RT-PCR; she was admitted to hospital for severe anaemia. The woman also tested positive to direct antiglobulin test (DAT). In addition, the literature was reviewed for cases of anaemia concomitant to COVID-19 and only cases of autoimmune haemolytic anaemia (AIHA) with positive DAT were considered. A total of 38 cases of AIHA concomitant to COVID-19 were identified. In the cases reported in the literature, both warm AIHA and cold agglutinin disease were observed, with a marked prevalence of CAD. The majority of the cases identified in the literature, including the patient described herein, have had a full recovery from both COVID-19 and AIHA; however, as some of the patients visited the hospital for observation when their condition was already at an advanced and severe stage, effective therapy could not be administered and they consequently succumbed. On the whole, as autoimmune anaemia may be a consequence of SARS-CoV-2 infection, it should perhaps be considered among the haematological autoimmune disorders secondary to COVID-19, along with thrombocytopenia.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

COVID‑19 infection and severe autoimmune haemolytic anaemia: A case report and review of the literature

Russotto,

Micali,

Marino

et al. 2023

World Acad Sci J

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“…PE in these patients is likely to be characterized by a multifactorial genesis due to the coexistence of both autoimmune haemolytic anaemia and Covid-19 infection and subsequent inflammatory response. Although SARS-CoV2 vaccinations have been linked to coagulopathies, we believe that the temporal relation between the onset of the Covid-19 infection and the diagnosis of wAIHA and the negative work-up for underlining disorders, suggests that, although mild in clinical display, the infection might have been the trigger for the development of autoimmune complications [22,23]. The association between AIHA and VTE is increasingly recognized in literature particularly within 90 days from disease onset and up to around 15-30% of adult patients presenting with wAIHA develop VTE, around 50% of which will develop PE.…”

Section: Discussionmentioning

confidence: 94%

Pulmonary Embolism as a Complication of Sars- Cov-2 Infection and Complement Mediated Autoimmune Hemolytic Anemia

2023

Ann Case Report

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SARS-Cov2 infection, especially in the acute phase, has been in many cases associated to the development of hypercoagulable states and a subsequent increased risk of venous thromboembolism [1]. The prevalence of pulmonary embolism (PE) has been shown to be higher in COVID-19 hospitalized patients compared to critically ill ones who test negative for the viral infection [2]. This is the reason why current guidelines of the International Society of Thrombosis and Haemostasis recommend the administration of thromboembolic prophylaxis in all hospitalized patients with SARS-CoV-2 infection or the use of a therapeutic dose of anticoagulant in the most critical cases. Although the pathophysiology underlying the onset of hypercoagulability during SARS-CoV-2 infection is yet not fully understood, the triggering of a powerful inflammatory response together with the role of cytokines and angiotensin converting enzyme 2 (ACE2) receptor, have shown to be able to induce endothelial cell dysfunction and damage with the subsequent onset of hypercoagulability [1]. The presence of activated neutrophils and macrophages in the target tissues has been associated with the induction of neutrophil extracellular traps (NETs) and thrombocytogenesis, promoting vascular collapse, respiratory distress up to a stage of multiorgan failure [3]. Several studies analysing the potential role of SARS-Cov-2 have shown that viral infection can induce immune system dysregulation through phenomena of epitope spreading, bystander activation, cross-reaction or molecular mimicry [4]. In particular, a limited number of autoimmune haemolytic anaemia (AIHA) cases have been reported in patients with SARS-CoV-2 infection, especially in those presenting with a severe clinical displays [5]. Here we report the case of a patient who was admitted to our Internal Medicine Ward diagnosed with warm autoimmune haemolytic anaemia (wAIHA) and pulmonary embolism (PE) with a recent COVID-19 infection.

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“…Individuals who followed for 6 months, with at least one Long COVID-19-related symptom, had a significantly higher mean corpuscular hemoglobin concentration (MCHC) than those who recovered with no signs ( Alfadda et al, 2022 ). Higher MCHC can have multiple causes, including autoimmune hemolytic anemia, and rare events have been reported in COVID-19 ( Lazarian et al, 2020 ; Al-Mashdali et al, 2021 ; Fattizzo et al, 2021 ).…”

Section: Hematological Alterations In Sub-acute and Long Covid-19mentioning

confidence: 99%

Hematological alterations associated with long COVID-19

2023

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Long COVID-19 is a condition characterized by persistent symptoms lasting beyond the acute phase of COVID-19. Long COVID-19 produces diverse symptomatology and can impact organs and systems, including the hematological system. Several studies have reported, in COVID-19 patients, hematological abnormalities. Most of these alterations are associated with a higher risk of severe disease and poor outcomes. This literature review identified studies reporting hematological parameters in individuals with Long COVID-19. Findings suggest that Long COVID-19 is associated with a range of sustained hematological alterations, including alterations in red blood cells, anemia, lymphopenia, and elevated levels of inflammatory markers such as ferritin, D-dimer, and IL-6. These alterations may contribute to a better understanding of the pathophysiology of Long COVID-19 and its associated symptoms. However, further research is needed to elucidate the underlying mechanisms and potential treatments for these hematological changes in individuals with Long COVID-19.

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Concomitant autoimmune hemolytic anemia and pulmonary embolism associated with mild COVID‐19: A case report

Abstract: Despite its rarity, AIHA can be associated with COVID‐19. It should be suspected in a patient with recent COVID‐19 presenting with unexplained anemia.

Cited by 3 publications

References 16 publications

COVID‑19 infection and severe autoimmune haemolytic anaemia: A case report and review of the literature

COVID‑19 infection and severe autoimmune haemolytic anaemia: A case report and review of the literature

Pulmonary Embolism as a Complication of Sars- Cov-2 Infection and Complement Mediated Autoimmune Hemolytic Anemia

Hematological alterations associated with long COVID-19

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