Delayed, transient and self-resolving neutropenia following COVID-19 pneumonia

Abstract

A novel coronaravirus, identified as SARS-CoV-2, spread throughout the world in 2020. The COVID-19 pandemic has led to many discoveries and clinical manifestations. A young patient is presented with new, self-resolving neutropenia presenting weeks after a prolonged hospital stay for COVID-19 pneumonia. Workup included analysis for underlying infection, nutritional abnormalities, malignancy, medication and toxin exposure, all of which were negative. From 2020 to the present, few reports have described neutropenia associated with a recent COVID-19 infection. In particular, no reports have described a delayed presentation of neutropenia. The authors would like to propose that the significant inflammatory response associated with COVID-19 is likely what led to this patient’s postviral neutropenia. Furthermore, in young healthy patients, bone marrow biopsy may be deferred and a watchful-waiting approach may be taken to assess for neutropenia resolution.

Ethnicity-Specific Features of COVID-19 Among Arabs, Africans, South Asians, East Asians, and Caucasians in the United Arab Emirates

“…Coronaviruses are able to infect bone marrow cells, which can result in abnormal hematopoiesis ( Desai et al., 2021 ). That is why SARS-CoV2 infection can cause several hematological abnormalities ( Mank et al., 2021 ). The most common abnormalities in COVID-19 include neutrophilia, lymphopenia, and thrombocytopenia.…”

Self-limiting severe neutropenia in a patient with COVID-19

“…12 13 On day 3, ANCs were>1200/µL, other routine laboratory investigations were also normal and the patient also improved clinically from COVID-19. Thus, it is learnt from this experience and available literature that an early or delayed severe neutropenia could be found during severe COVID-19 infection [2][3][4] and could be a result…”

“…The previous studies do not mention neutropenia as a manifestation of COVID-19 infection. There are only a few previous case reports on neutropenia in otherwise immunocompetent adult patients2–4 and an infant 5. The neutropenia in patients with COVID-19 with haematological malignancy6 7 or solid tumour8 has also been reported.…”

“…We had also screened our patients for any drug-induced cytopenia but did not found any offending agent. The patient was further evaluated for neutropenia as described in the previous studies2–4 11 After a thorough clinical history and physical examination, we evaluated the patient for any other concurrent viral or protozoan infections known to cause cytopenia. An autoimmune screening, peripheral blood smear and blood level of folate, vitamin B 12 and iron were also done.…”

“…of transient bone marrow suppression by significant inflammatory response during viral infection. 4 It could be the possibility that like certain other viral illnesses, it is one of the haematological manifestations that is yet under-reported as most cases are asymptomatic and may go unnoticed. Haematologists should be involved in the management of such cases and any concurrent illnesses causing neutropenia should be ruled out.…”