SARS‐CoV‐2 infection in two pediatric patients with immune cytopenias: A single institution experience during the pandemic

Rosenzweig, Jaclyn D.; McThenia, Sheila S.; Kaicker, Shipra

doi:10.1002/pbc.28503

Cited by 34 publications

(40 citation statements)

References 6 publications

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“…Immune thrombocytopenic purpura (ITP) can occur secondary to COVID-19 infections. A systematic approach is essential to diagnose new-onset ITP after excluding several concomitant factors or conditions that can cause thrombocytopenia in COVID- 19. ITP has been found to be more common in elderly and moderate-to-severe COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Median age of the study population was 62 years. Only 3 patients (7%) were in the pediatric age group [18,19,22]; 32 (71%) patients were above 50 years of age. Needless to say, majority of the study population had wide range of comorbidities.…”

Section: Demographic Profile and Baseline Characteristicsmentioning

confidence: 99%

“…Three patients (7%), who tested positive for COVID-19, did not give any history of fever or other typical flu-like symptoms and were considered to be asymptomatic [15,21]. Among patients with individual data of clinical recovery of COVID-19 symptoms (N = 28), ITP presented in 6 patients (21.5%) in postrecovery period [7,11,16,19,22,28,29]. Among these 5 patients, one was negative for COVID-19 at ITP onset [7].…”

Section: Demographic Profile and Baseline Characteristicsmentioning

confidence: 99%

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Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

Bhattacharjee

Banerjee

2020

SN Compr. Clin. Med.

270

325

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Immune thrombocytopenia, often known as immune thrombocytopenic purpura (ITP), has emerged as an important complication of COVID-19. A systematic review was done to analyze the clinical profile and outcomes in a total of 45 cases of new-onset ITP in COVID-19 patients described in literature until date. A comprehensive approach is essential for diagnosing COVID-19associated ITP after excluding several concomitant factors that can cause thrombocytopenia in COVID-19. Majority of ITP cases (71%) were found to be elderly (> 50 years) and 75% cases had moderate-to-severe COVID-19. Three patients (7%) were in the pediatric age group. Reports of ITP in asymptomatic COVID-19 patients (7%) underscore the need for COVID-19 testing in newly diagnosed patients with ITP irrespective of COVID-19 symptoms amid this pandemic. ITP onset occurred in 20% cases 3 weeks after onset of COVID-19 symptoms, with many reports after clinical recovery. SARS-CoV-2-mediated immune thrombocytopenia can be attributed to the underlying immune dysregulation, susceptibility mutations in SOCS 1, and other mechanisms, including molecular mimicry, cryptic antigen expression, and epitope spreading. No bleeding manifestations were reported in 31% cases at diagnosis. Severe life-threatening bleeding was uncommon. One case of mortality was attributed to intracranial hemorrhage. Secondary Evans syndrome was diagnosed in one case. Good initial response to short course of glucocorticoids and intravenous immunoglobulin has been found with the exception of delayed lag response in one case. Thrombopoietin receptor agonist usage as a second-line agent has been noted in few cases for short duration with no adverse events. In the relatively short follow-up period, four relapses of ITP were found.

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Section: Discussionmentioning

confidence: 99%

Section: Demographic Profile and Baseline Characteristicsmentioning

confidence: 99%

Section: Demographic Profile and Baseline Characteristicsmentioning

confidence: 99%

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Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

Bhattacharjee

Banerjee

2020

SN Compr. Clin. Med.

270

325

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“…In COVID-19 patients, iatrogenic active bleeding [14] or secondary to disseminated intravascular coagulation (DIC) can also potentially contribute to anemia [15]. On the other hand, a plethora of reports showed that SARS-CoV-2infected individuals developed autoimmune hemolytic anemia (AIHA) [16][17][18][19][20]. Nevertheless, the prevalence and implications of such findings remain to be elucidated.…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of hemoglobin level and autoimmune hemolytic anemia in SARS-CoV-2 infection

et al. 2020

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Higher levels of D-dimer, LDH, and ferritin, all have been associated with the poor prognosis of COVID-19. In a disease where there are acute inflammation and compromised oxygenation, we investigated the impact of initial hemoglobin (Hgb) levels at Emergency Department (ED) triage on the severity and the clinical course of COVID-19. We conducted a cross-sectional study on 601 COVID-19 patients in a COVID-19 national referral center between 13 and 27 June 2020. All adult patients presented at our hospital that required admission or hotel isolation were included in this study. Patients admitted to the intensive care unit (ICU) had a lower initial Hgb than those admitted outside the ICU (12.84 g/dL vs. 13.31 g/dL, p = 0.026) and over the course of admission; the prevalence of anemia (Hgb < 12.5 g/dL) was 65% in patients admitted to ICU, whereas it was only 43% in non-ICU patients (odds ratio of 2.464, 95% CI 1.71-3.52). Anemic ICU patients had a higher mortality compared with non-anemic ICU patients (hazard ratio = 1.88, log-rank p = 0.0104). A direct agglutination test (DAT) for all anemic patients showed that 14.7% of ICU patients and 9% of non-ICU patients had autoimmune hemolytic anemia (AIHA). AIHA patients had significantly longer length of hospital stay compared with anemic patients without AIHA (17.1 days vs. 14.08 days, p = 0.034). Lower Hgb level at hospital presentation could be a potential surrogate for COVID-19 severity.

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“…The presence of cold agglutinins in COVID 19 patients has been observed in several reports which showed that SARS-CoV-2-infected individuals developed autoimmune hemolytic anemia (AIHA) [2][3][4][5][6][7][8]. Nevertheless, the prevalence and implications of such findings remain to be elucidated.…”

Section: Discussionmentioning

confidence: 96%

Serological Blood Group Discrepancy and Cold Agglutinin Autoimmune Hemolytic Anemia Associated With Novel Coronavirus

Raghuwanshi¹

2020

Cureus

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A case of a 45-year-old male presentation with viral pneumonia with anemia and thrombocytopenia and was admitted to COVID-19 ICU. The blood bank encountered a discrepancy in blood grouping and cross-match, which were subsequently resolved. The patient presented to the emergency room with fever and shortness of breath. He had tachycardia, fever, and had an oxygen saturation of 88% on room air. His SARS-CoV-2 RT-PCR test was positive. Total and unconjugated bilirubin was raised. Due to the anemia and falling haemoglobin, he was not started on any anticoagulation. On investigation, the patient's direct Antiglobulin test was positive. Cold agglutinin titer at 4-degree Celsius was 64. The blood sample showed auto agglutination at collection and discrepancy in blood grouping and cross-matching, which were subsequently resolved. As observed in this case report, COVID-19 infection can be associated with cold agglutinin disease and Autoimmune hemolytic anemia, and cold agglutinins should be recognized as potentially significant due to interference with laboratory investigations and complications associated with COVID 19.

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SARS‐CoV‐2 infection in two pediatric patients with immune cytopenias: A single institution experience during the pandemic

Cited by 34 publications

References 6 publications

Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

Immune Thrombocytopenia Secondary to COVID-19: a Systematic Review

Prognostic significance of hemoglobin level and autoimmune hemolytic anemia in SARS-CoV-2 infection

Serological Blood Group Discrepancy and Cold Agglutinin Autoimmune Hemolytic Anemia Associated With Novel Coronavirus

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