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

Abstract

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.

Complement Mediated Hemolytic Anemias in the COVID-19 Era: Case Series and Review of the Literature

“…Available literature regarding CAD development or reactivation during COVID-19 infection is summarized in Table 3 (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42). From March 2020, we found 20 reports of patients experiencing cold agglutinin mediated hemolysis after COVID-19 infection (11 males, 9 females, aged from 17 to 77 years).…”

Can SARS-CoV-2 trigger new onset of autoimmune disease in adults? A case-based review

“…When a person's immune system attacks their own red blood cell antigens, this results in AIHA [ 56 ]. AIHA is classified serologically as warm, cold, or mixed 57 , 58 , 59 , 60 . We found five case reports describing the occurrence of AIHA following mild and severe SARS-CoV-2 infection 56 , 57 , 58 , 59 , 60 .…”

“…AIHA is classified serologically as warm, cold, or mixed 57 , 58 , 59 , 60 . We found five case reports describing the occurrence of AIHA following mild and severe SARS-CoV-2 infection 56 , 57 , 58 , 59 , 60 . LDH and bilirubin levels may rise, while haptoglobin levels may fall.…”

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“…Coagulopathy is associated with an increased risk of death in patients with COVID-19 [36]. The presence of cold agglutinins in COVID 19 patients have also been reported in many studies [37]. To deal with COVID 19 associated coagulopathy, we assured to make available sufficient quantity of fresh frozen plasma (FFP), cryoprecipitate, platelet concentrate (PC) and single donor apheresis platelet (SDAP) for COVID-19 patients in our blood bank.…”