Hemolytic Anemia Complicating COVID-19 Infection

AbouYabis, Abeer N.; Bell, Grace Thompson

doi:10.14740/jh906

Cited by 19 publications

(12 citation statements)

References 28 publications

(24 reference statements)

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“…Autoimmune hemolytic anemia (AIHA) is acquired hemolysis wherein the host’s immune system attacks the host’s red blood cells antigens. AIHA or suspected AIHA in the setting of COVID-19-induced hyperinflammation has been reported in several studies [ 130 – 133 ]. Hemolytic anemia in COVID-19 appears to be multifactorial.…”

Section: Interplay Of Iron Parameters In Covid-19mentioning

confidence: 99%

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Iron and iron-related proteins in COVID-19

Suriawinata

Mehta

2022

Clin Exp Med

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COVID-19 can cause detrimental effects on health. Vaccines have helped in reducing disease severity and transmission but their long-term effects on health and effectiveness against future viral variants remain unknown. COVID-19 pathogenesis involves alteration in iron homeostasis. Thus, a contextual understanding of iron-related parameters would be very valuable for disease prognosis and therapeutics.Accordingly, we reviewed the status of iron and iron-related proteins in COVID-19. Iron-associated alterations in COVID-19 reported hitherto include anemia of inflammation, low levels of serum iron (hypoferremia), transferrin and transferrin saturation, and high levels of serum ferritin (hyperferritinemia), hepcidin, lipocalin-2, catalytic iron, and soluble transferrin receptor (in ICU patients). Hemoglobin levels can be low or normal, and compromised hemoglobin function has been proposed. Membrane-bound transferrin receptor may facilitate viral entry, so it acts as a potential target for antiviral therapy. Lactoferrin can provide natural defense by preventing viral entry and/or inhibiting viral replication. Serum iron and ferritin levels can predict COVID-19-related hospitalization, severity, and mortality. Serum hepcidin and ferritin/transferrin ratio can predict COVID-19 severity. Here, serum levels of these iron-related parameters are provided, caveats of iron chelation for therapy are discussed and the interplay of these iron-related parameters in COVID-19 is explained.This synopsis is crucial as it clearly presents the iron picture of COVID-19. The information may assist in disease prognosis and/or in formulating iron-related adjunctive strategies that can help reduce infection/inflammation and better manage COVID-19 caused by future variants. Indeed, the current picture will augment as more is revealed about these iron-related parameters in COVID-19.

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Section: Interplay Of Iron Parameters In Covid-19mentioning

confidence: 99%

“…These stimulate T cells, which in turn stimulate autoreactive B cells to generate antibodies against the cryptic antigens. The generated antibodies coat the red blood cells leading to a positive direct antiglobulin test in approximately 45% of COVID-19 patients [ 130 ].…”

Section: Interplay Of Iron Parameters In Covid-19mentioning

confidence: 99%

Iron and iron-related proteins in COVID-19

Suriawinata

Mehta

2022

Clin Exp Med

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“…AIHA following SARS-CoV-2 infection with either warm or cold autoantibodies has previously been documented in the literature [ 2 ]. The majority of the cases described in the literature were associated with warm AIHA [ 3 ]. To the best of our knowledge, this has been the first case in which a patient had tested positive for both warm and cold antibodies.…”

Section: Discussionmentioning

confidence: 99%

Hyperhemolysis in the Setting of Mixed-Autoimmune Hemolytic Anemia: A Rare Complication of COVID-19

Narula¹,

Winkle²,

Brand³

et al. 2021

Cureus

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel human pathogen known for its predilection on the respiratory system. Herein, we present a unique case in which a patient developed hyperhemolysis in the setting of mixed autoimmune hemolytic anemia (AIHA) secondary to SARS-CoV-2. A 33-years-old male with a past medical history of resolved immune thrombocytopenic purpura (ITP) presented to the hospital with symptoms of jaundice after being infected with SARS-CoV-2. On admission, his Hgb was 12.5 g/dL. Lab results showed indirect bilirubin of 13 mg/dL, LDH at 759 U/L, haptoglobin <10, and the percent reticulocyte count was 2.33%. A direct antiglobulin test (DAT) was also positive for C3, IgG, anti-E, in addition to both warm and cold autoantibodies. PCR was positive for COVID-19. Within two days of admission, his Hgb dropped to 5.9 g/dL. A total of seven units of packed red blood cell (pRBC) was required to achieve a Hgb of 6 g/dL in 48 hours. Patients with preexisting hematological abnormalities have a propensity to develop AIHA in the setting of the virus. The majority of the cases described in the literature were associated with warm AIHA. Our patient tested positive for both warm and cold antibodies, which may partially explain the mechanism behind hyperhemolysis in our patient.

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“…However, it is noteworthy that the use of these drugs is contraindicated in some conditions, particularly in G6PD deficiency [55]. When G6PD deficiency has not been diagnosed, the administration of HCQ for treatment of COVID-19 results in worse outcomes associated with hemolytic crisis [60]. Development of autoantibodies seems to be responsible for the hemolytic anemia associated with COVID-19 infection [54,61].…”

Section: Effects Of Decreased Activity Of G6pdmentioning

confidence: 99%

The Possible Role of Glucose-6-Phosphate Dehydrogenase in the SARS-CoV-2 Infection

Pérez-Torres

Soto²,

Guarner-Lans³

et al. 2022

Cells

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Glucose-6-phosphate dehydrogenase (G6PD) is the second rate-limiting enzyme of the pentose phosphate pathway. This enzyme is present in the cytoplasm of all mammalian cells, and its activity is essential for an adequate functioning of the antioxidant system and for the response of innate immunity. It is responsible for the production of nicotinamide adenine dinucleotide phosphate (NADPH), the first redox equivalent, in the pentose phosphate pathway. Viral infections such as SARS-CoV-2 may induce the Warburg effect with an increase in anaerobic glycolysis and production of lactate. This condition ensures the success of viral replication and production of the virion. Therefore, the activity of G6PD may be increased in COVID-19 patients raising the level of the NADPH, which is needed for the enzymatic and non-enzymatic antioxidant systems that counteract the oxidative stress caused by the cytokine storm. G6PD deficiency affects approximately 350–400 million people worldwide; therefore, it is one of the most prevalent diseases related to enzymatic deficiency worldwide. In G6PD-deficient patients exposed to SARS-CoV-2, the amount of NADPH is reduced, increasing the susceptibility for viral infection. There is loss of the redox homeostasis in them, resulting in severe pneumonia and fatal outcomes.

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Hemolytic Anemia Complicating COVID-19 Infection

Cited by 19 publications

References 28 publications

Iron and iron-related proteins in COVID-19

Iron and iron-related proteins in COVID-19

Hyperhemolysis in the Setting of Mixed-Autoimmune Hemolytic Anemia: A Rare Complication of COVID-19

The Possible Role of Glucose-6-Phosphate Dehydrogenase in the SARS-CoV-2 Infection

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