Prolonged Self-Resolving Neutropenia Following Asymptomatic COVID-19 Infection

Abstract

Multiple hematologic complications have been reported as a result of the novel coronavirus disease 2019 (COVID-19) infection. These include leukopenia, lymphopenia, thrombocytopenia as well as increased risk of venous thromboembolism. Neutropenia is a relatively uncommon finding, especially in asymptomatic patients with no other evidence of systemic infection. A young, healthy male undergoing training for the Navy was admitted with rhabdomyolysis following intense physical activity. He was incidentally noted to have severe neutropenia with the white blood cell (WBC) count of 2.1 × 10 9 /L and an absolute neutrophil count (ANC) of 355 cells/μL one month following prior asymptomatic COVID-19 infection. Further evaluation was negative for other infectious processes, nutritional deficiency, or underlying malignancy. Given young age without comorbidities and lack of febrile illness, watchful waiting was recommended in lieu of bone marrow biopsy which resulted in spontaneous resolution of neutropenia and normalization of WBC. The authors argue that although most hematologic complications of COVID-19 are reported in symptomatic patients, asymptomatic patients also appear to have a risk of developing hematologic complications including bone marrow suppression. Watchful waiting may be an appropriate diagnostic approach in such young, healthy individuals.

Ethnicity-Specific Features of COVID-19 Among Arabs, Africans, South Asians, East Asians, and Caucasians in the United Arab Emirates

“…COVID-19 can manifest with a profound inflammatory response, which may cause severe immune damage to the lungs. Coronaviruses are able to infect bone marrow cells, which can result in abnormal hematopoiesis ( Desai et al., 2021 ). That is why SARS-CoV2 infection can cause several hematological abnormalities ( Mank et al., 2021 ).…”

“…Lymphopenia leads to the dysfunction of immune system in severe COVID-19 and makes the patients vulnerable to bacterial infections ( Chen et al., 2020 ; Sun et al., 2020 ). Pronounced lymphopenia and thrombocytopenia carry poor prognosis especially if accompanied by the elevated D-dimer level ( Desai et al., 2021 ). Both neutrophilia and neutropenia are predictive of poor outcomes and severe respiratory failure in this category of patients ( López-Pereira et al., 2020 ).…”

Agranulocytosis following intravenous immunoglobulin administration in a patient with Guillain-Barré Syndrome triggered by COVID-19: A case report

“…Only a few cases of neutropenia have been reported in patients during recovery after COVID-19. [1][2][3][4][5]8 Immune-mediated neutropenia is also unlikely given a rapid and stable response to a single dose of G-CSF. It should be emphasized that no other infection was identified, as well as other immune or paraneoplastic disorders.…”

“…Neutropenia during recovery after coronavirus disease 2019 (COVID-19), as well as neutropenia after intravenous immunoglobulin (IVIG) administration are very rare hematological abnormalities. [1][2][3][4][5][6][7][8] We report the first case of agranulocytosis following IVIG administration in patients with Guillain-Barre syndrome (GBS) triggered by COVID-19.…”

Coexistence of Pancytopenia and Myositis After Developing COVID-19

“…Myositis and pancytopenia rarely coexist in patients as COVID-19 complications. Only a few case reports on patients with the same conditions, especially among older patients, have been published [9,10]. We describe this rare case and discuss how COVID-19 causes these complications and the appropriate treatment for these patients in rural hospitals.…”