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.

Keywords

viral infection - thrombosis - autoantibodies

• References

• 1 Coronavirus Resource Center. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU).. Available at: https://coronavirus.jhu.edu/map.html . Accessed May 11, 2020
• 2 Huang C, Wang Y, Li X. , et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
• 3 Tong JY, Wong A, Zhu D, Fastenberg JH, Tham T. The prevalence of olfactory and gustatory dysfunction in covid-19 patients: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2020; 163 (01) 3-11
• 4 Gianniis D, Ziogas IA, Gianni P. Coagulationi disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol 2020; 127: 1-4
• 5 Helms J, Tacquard C, Severac F. , et al; CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med 2020; 46 (06) 1089-1098
• 6 Haemolytic Anaemia. Johns Hopkins Medicine. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/haemolytic-anaemia . Accessed May 11, 2020
• 7 Wang YD, Zhang SP, Wei QZ. , et al. [COVID-19 complicated with DIC: 2 cases report and literatures review] (in Chinese). Zhonghua Xue Ye Xue Za Zhi 2020; 41 (03) 245-247
• 8 Broome CM, Cunningham JM, Mullins M. , et al. Increased risk of thrombotic events in cold agglutinin disease: A 10-year retrospective analysis. Res Pract Thromb Haemost 2020; 4 (04) 628-635
• 9 Chapin J, Terry HS, Kleinert D, Laurence J. The role of complement activation in thrombosis and hemolytic anemias. Transfus Apheresis Sci 2016; 54 (02) 191-198
• 10 Bleakly NT, Fontaine MJ, Pate LL, Sutherland SM, Jeng M. Disseminated intravascular coagulation due to IgM-mediated autoimmune hemolytic anemia. Pediatr Blood Cancer 2011; 57 (02) 329-331
• 11 Berentsen S. New insights in the pathogenesis and therapy of cold agglutinin-mediated autoimmune hemolytic anemia. Front Immunol 2020; 11: 590
• 12 Berentsen S. Cold agglutinin disease. Hematology (Am Soc Hematol Educ Program) 2016; 2016 (01) 226-231
• 13 Lazarian G, Quinquenel A, Bellal M. , et al. Autoimmune haemolytic anaemia associated with COVID-19 infection. Br J Haematol 2020; 190 (01) 29-31 ; [Epub ahead of print]
• 14 Wongsaengsak S, Czader M, Suvannasankha A. Cold agglutinin-mediated autoimmune haemolytic anaemia associated with diffuse large B cell lymphoma. BMJ Case Rep 2018; 2018: bcr-2017-222064
• 15 Chu CS, Braun SR, Yarbro JW, Hayden MR. Corticosteroid treatment of hemolytic anemia associated with Mycoplasma pneumoniae pneumonia. South Med J 1990; 83 (09) 1106-1108