Coagulation Abnormalities Due to COVID-19 in a Child with Thalassemia

Marhaeni, Wulandewi; Wijaya, Andreas Budi; Khairiyadi,; Munawaroh,; Hendriyono,

doi:10.1007/s12098-020-03600-9

Cited by 6 publications

(4 citation statements)

References 5 publications

(5 reference statements)

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“…Mild COVID-19 was reported among 4 transfusiondependent β-thalassemia children from Indonesia. However, coagulation abnormality was detected in 1 patient without developing clinical thrombosis and with elevated D-dimer (24). In 2 young Pakistani patients, mild SARS-CoV-2 infection was reported (10,25).…”

Section: Case Reportsmentioning

confidence: 94%

Thalassemia and COVID-19: Susceptibility and Severity

et al. 2021

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Context: COVID-19 results in an imbalance between procoagulant and anticoagulant homeostatic mechanisms that could be complicated with thrombotic events. In β-thalassemia patients, the presence of comorbidities, iron overload, adrenal hypofunction, splenectomy, and chronic hypercoagulable state might increase the susceptibility to COVID-19 and its severity. Evidence Acquisition: The search was conducted in PubMed, Web of Science, and Scopus databases for the key terms of β-thalassemia/thalassemia and COVID-19 until July 2021. Results: The survey of published observational studies (mostly multicenter and case reports) indicated a lower prevalence of COVID-19 in β-thalassemia patients compared with the general population, as well as mild to moderate COVID-19 in these patients, especially in those without comorbidity. β-Thalassemia children were susceptible to COVID-19 but with less severity compared to adults. There is no report of pulmonary embolism and thrombotic events in β-thalassemia patients with COVID-19; however, coagulation abnormality and pulmonary microembolism have been found in these patients. Conclusions: Findings could be interpreted by the presence of high hemoglobin F (HbF) levels, the advantage of hydroxyurea (HU) therapy, splenectomy, and iron chelation therapy in these patients. However, due to the low sample size and studying mainly young patients, the results should be interpreted with caution, and it still needs more studies with a larger sample size to confirm these findings.

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Section: Case Reportsmentioning

confidence: 94%

Thalassemia and COVID-19: Susceptibility and Severity

et al. 2021

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“…A multitude of case reports showcasing the outcomes of COVID-19 infection in patients with hemoglobinopathies has been published. From Indonesia, four beta-thalassemia pediatric patients developed mild COVID-19 infection with one developing thrombosis supported by elevated D-dimer [34]. In Italy, a 59-year-old woman who was transfusion-dependent developed a mild COVID-19 infection [35].…”

Section: Review Of Case Reportsmentioning

confidence: 99%

Effects of Beta-Thalassemia on COVID-19 Outcomes

Patel,

Shah,

Kaiser

et al. 2023

Thalassemia Syndromes - New Insights and Transfusion Modalities

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Beta-thalassemia is a hemoglobinopathy caused by mutations in the beta-globin chain. This disrupts hemoglobin production and can potentially result in severe anemia. There has been a rise in COVID-19 cases over the last 2 years, with a predominant effect on the respiratory and vascular systems of the body. Since beta-thalassemia is the most common inherited single-gene disorder in the world, investigating the impact of COVID-19 on these patients is important. Some theories suggest that patients with beta-thalassemia will be more susceptible to COVID-19 and have worse outcomes due to their underlying comorbid conditions. However, majority of the literature found that beta-thalassemia is protective against COVID-19. This could be because SARS-CoV-2 proteins can attack the beta chain of normal hemoglobin, resulting in impaired oxygen transfer and increased ferritinemia. Thus, in hemoglobinopathies with beta-chain defects and low hepcidin levels, susceptibility to COVID-19 infection is potentially decreased. Higher levels of Hemoglobin F in thalassemia patients may also be protective against viral infections. Surprisingly, most studies and case reports focus on patients with beta-thalassemia major. There is yet much to learn about the outcomes of patients with thalassemia minor and other hemoglobinopathies.

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“…To the Editor: We would like to share ideas on the article “Coagulation Abnormalities Due to COVID-19 in a Child with Thalassemia” by Marhaeni et al The authors concluded that “Dysregulation of the coagulation cascade is prominent findings in SARS-Cov-2 infection associated with transfusion-dependent-thalassemia [ 1 ].” Indeed, thalassemia is a congenital hemoglobin disorder that has several underlying pathological problem including vaso-occlusive crises (VOC) that can superimpose the pathological problem induced by COVID-19 [ 2 ]. However, the observed abnormal coagulation profile might also be related to other problem.…”

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confidence: 99%