COVID-19 and Cold Agglutinin Hemolytic Anemia

Abstract

Novel coronavirus disease 2019 (COVID-19) has spread throughout the world and has infected close to 4 million people. It commonly presents with fever, cough, and fatigue. Due to the high inflammatory response, it is suggested that the coagulation cascade is enhanced causing thrombotic events for many patients. We describe a patient with clinical features of cerebrovascular accident, as well as documented blood clots in bilateral upper extremities. Labs revealed the presence of cold agglutinin hemolytic anemia. The association between cold agglutinin autoimmune hemolytic anemia and thrombotic events in COVID-19 patients has not been well investigated. The patient unfortunately passed away within 48 hours after admission. This case stresses the importance of considering a full workup to diagnose autoimmune hemolytic anemia (AIHA) in COVID-19 patients with thromboses and possible implications for management.

Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

“…Positive direct Coomb's test was shown in 13% of 267 anemic COVID-19 patients and 46% of the other 113 COVID-19 patients (114,115). Furthermore, both warm and cold AIHA have been reported in COVID-19 patients and most of them recovered spontaneously (116)(117)(118)(119)(120)(121)(122). In line with these findings, a 39-year-old man was found to have concomitant Evans syndrome and COVID-19 infection (123).…”

Cold agglutinin-mediated autoimmune hemolytic anemia associated with COVID-19 infection

“…Till date, there are two case reports describing thromboembolism in patients with COVID-19 infection and cold agglutinin disease. Patil et al described a case of CAD with AIHA, and pulmonary embolism as a presentation of COVID-19 infection, while Maslov et al reported a patient with COVID-19 infection and cold agglutinin hemolytic anemia complicated with stroke and venous thrombosis of bilateral upper extremities [10,11] However, our patient did not exhibit any features of thromboembolism. While patients with COVID-19 infection are generally at elevated risk of thromboembolic complications, AIHA/CAD should be considered as a possible contributory factor.…”

Acute Tubular Necrosis Associated with Autoimmune Hemolytic Anemia due to Acute Gastroenteritis

“…12 Most recently, about 20 cases of AIHAs (both cold and warm forms) secondary to COVID-19 infection have been reported, with only one fatality. 13 As a result, this case shows us that, although rare, acute tubular necrosis can be seen together with AIHA associated with acute gastroenteritis.…”