Gastrointestinal bleeding in a newborn infant with congenital factor X deficiency and COVID‐19—A common clinical feature between a rare disorder and a new, common infection

Abstract

Congenital factor X (FX) deficiency is an extremely rare, bleeding disorder with an estimated incidence of one per 1 million. Patients with severe FX deficiency (FX:C < 1%) demonstrate a wide spectrum of serious clinical presentations, including hemarthrosis, hematoma, gastrointestinal (GI) bleeding, intracranial hemorrhage (ICH), and umbilical cord bleeding. 1 In fact, severe FX deficiency, with a high rate of life-threatening bleeding, is the second-most severe, rare coagulation factor deficiency (RCFD) after FXIII deficiency. 1,2 Although homozygotes are at risk of severe bleeding, heterozygotes usually are asymptomatic, but postsurgical bleeding or bleeding after childbirth may occur. 1,2 Other risk factors can increase the risk of bleeding in FX deficiency, and coronavirus disease 2019 (COVID-19), a new medical challenge, could affect the patient's bleeding or thrombotic tendency. 3 COVID-19, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presents an enormous challenge for everyone, especially for those with underlying risk factors such as cardiovascular disease, diabetes, obesity, and renal failure. Age and male sex are other risk factors. 4 Limited data are available regarding the effect of COVID-19 on patients with congenital bleeding disorders (CBDs), particularly RCFDs. 5 It has been shown that hypercoagulability-related adverse consequences are less common among patients with CBDs, at least in those with moderate-to-severe deficiency, but further studies, including our ongoing work on a large number of patients, are required. 5 Although there are several

Maternal and Neonatal Complications, Outcomes and Possibility of Vertical Transmission in Iranian Women with COVID-19

“…Laboratory finding of the newborns is listed in Table S5. 9,10,23,24 Four patients had low lymphocyte counts and other significant changes were not reported in other tests.…”

“…Additionally, the study by Dorgalale et al 9 was found eligible because the neonate returned to hospital with symptoms on the day he was discharged. In another case series by Schwartz et al, 10 10 cases were excluded because the mothers' RT-PCR was negative or not reported and one case was excluded because the neonate was discharged after delivery.…”

“…Table S4 of Supplementary file 1 summarizes the clinical findings and symptoms of the newborns. 9,10,11,18,[23][24][25][26] Eleven (64.7%) neonates were transferred to NICU after delivery and 14 (82.3%) neonates developed respiratory distress syndrome (RDS). No case of sepsis was reported and we did not observe any other significant adverse complications among them except two cases of pulmonary hemorrhage reported by Sagheb et al and Rashidian et al 26 Ten neonates had COVID-19-related findings in their CT-scan or chest X-ray (CXR).…”

“…Three newborns were positive on day 1, whereas six neonates had a negative result on day 1 (Table S6). [9][10][11]18,[23][24][25][26] On the average, the neonate's PCR test became positive on day 4 for the first time. Amniotic fluid test was positive in three mothers and SARS-CoV-2 antigens were also detected in vaginal secretion of an infected mother.…”

The Relationship between Inflammatory Cytokines and Coagulopathy in Patients with COVID-19

“…Less commonly, diarrhea, anorexia, diminished smell and taste, and headache are reported. Gastrointestinal (GI) bleeding, hiccups, and central nervous system (CNS) bleeding occur rarely [ 2 , 3 ]. Patients with underlying risk factors such as elevated blood pressure, obesity, cardiovascular diseases, diabetes, renal failure, etc., may experience a more severe course of coronavirus disease 2019 (COVID-19) [ 4 ].…”