A 3-Case Series of Autoimmune Haemolytic Anaemia and COVID-19: Is Plasma Exchange an Alternative?

Abstract

COVID-19 has rarely been associated with immune-mediated phenomena such as autoimmune haemolytic anaemia (AIHA). Both cold hemolysis with cold agglutinin detection and warm haemolysis have been described with variable prognoses. Current treatment regimens are based on experience with other case series and case reports, which still represent a clinical challenge. Corticosteroids, red cell transfusions and rituximab have been successfully employed. We present 3 cases of AIHA in the context of COVID-19 disease, the first case successfully treated with plasma exchange and long-term follow-up of the 3 cases showing complete remission of anaemia.

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).…”

Concomitant autoimmune hemolytic anemia and pulmonary embolism associated with mild COVID‐19: A case report

“…The average time between the onset of COVID‐19 symptoms to the development of AIHA is around eight days. 7 Of note, most patients who developed AIHA had a moderate‐severe COVID‐19, and the inflammatory markers were notably elevated 7 , 8 ; however, AIHA can occur even in patients with asymptomatic COVID‐19. 6 Moreover, a few of those patients had preexisting comorbidities, such as chronic lymphatic leukemia idiopathic thrombocytopenic purpura, or lymphomas, suggesting a possible underlying immunological phenomenon.…”

“… 6 Moreover, a few of those patients had preexisting comorbidities, such as chronic lymphatic leukemia idiopathic thrombocytopenic purpura, or lymphomas, suggesting a possible underlying immunological phenomenon. 8 The pathophysiology of COVID‐19 related AIHA is still not well‐understood. At the beginning of the COVID‐19 era, given that most of the AIHA events were associated with severe cases, it has been postulated that dysregulated immune system activation could be the likely cause through attacking of the red blood cells resulting in their hemolysis.…”

“… 9 , 10 The evidence for the treatment of COVID‐19‐related AIHA is scarce and based mainly on the reported cases, although glucocorticoid therapy has been shown to be very effective and most of the cases improved dramatically after commencing glucocorticoid therapy. 5 , 6 , 7 , 8 …”

SARS-CoV-2 and Autoimmune Cytopenia

“…In all other cases with available information, hemolysis resolved and patients recovered. Rituximab therapy [52] and plasma exchange were successfully used in one case each [51]. CAD-coronary artery disease, CLL-chronic lymphocytic leukemia, COPD-chronic obstructive pulmonary disease, DCIS-ductal carcinoma in situ, DM-diabetes mellitis, ESRD-end stage renal disease, G6PD-glucose-6-phosphate dehydrogenase, ITP-immune thrombocytopenic purpura, HTN-hypertension, IVIG-intravenous immunoglobulin, MS-multiple sclerosis, PE-pulmonary embolism, DVT-deep vein thrombosis.…”