Patients with sickle cell disease and suspected COVID‐19 in a paediatric intensive care unit

Heilbronner, Claire; Berteloot, Laureline; Trémolières, P.; Dupic, Laurent; Blanquat, L. de Saint; Lesage, Fabrice; Odièvre, Marie Hélène; Marcellus, Charles de; Fourgeaud, Jacques; Montalembert, M. De; Grimaud, Marion; Moulin, F.; Renolleau, Sylvain; Allali, Slimane; Oualha, Mehdi

doi:10.1111/bjh.16802

Cited by 40 publications

(50 citation statements)

References 10 publications

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“…Furthermore, the association between acute chest syndrome in patients with SCD and SARS-CoV-2 infection is intriguing. Indeed, the high number of similar cases in the literature so far suggests a poor tolerance of COVID-19 in patients with SCD, probably due to the SCD vasculopathy that worsens SARS-CoV-2 pathogenicity in the lungs [ 19 , 20 , 21 , 22 , 23 ]. However, in the described teenagers, despite the severe initial presentation, even when burdened by a preexisting chronic disease such as SCD, obesity or epilepsy, no fatal evolution was observed in this pediatric series, and all of the patients recovered without any sequelae [ 22 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

The Wide Spectrum of COVID-19 Clinical Presentation in Children

Nathan

Prévost

Sileo

et al. 2020

JCM

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Background: Ten months after its appearance in December 2019, SARS-CoV-2 has infected more than 25 million patients worldwide. Because children were first identified as potential spreaders of the virus, schools were closed in several countries. However, it rapidly became evident that the number of hospitalized children infected by SARS-CoV-2 was dramatically lower than that of adults. To date, only hypotheses have been raised to explain this difference, so it is of great importance to describe the presentation of this disease among children. Here, we describe a wide spectrum of COVID-19 manifestation in children in a dedicated pediatric unit in France. Methods: Patients hospitalized with COVID-19 who were diagnosed on the basis of either positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs and/or typical aspects in chest-computed tomography (CT) were included between March and May 2020 in Paris. Results: Twenty-three patients were included on the basis of positive RT-PCR (n = 20) and/or typical aspects in CT (n = 4). The median age was 4.9 years [0.1–17.6]. Patients were grouped by age (<2 years old: n = 14, 61%; 2–10 years old: n = 2, 9%; >10 years old: n = 7, 30%). Overweight or obesity was reported in only three patients. At presentation, the most frequent symptom in the overall cohort was fever (n = 18, 78%), followed by acute rhinitis (n = 9, 64%) and cough (n = 7, 50%) in the under 2-year-old group and cough (n = 4, 57%), fatigue, dyspnea and abdominal pain (n = 3, 43% each) in the over 10-year-old group. Five patients required ICU treatment, four of whom were aged >10 years, two presented with acute myocarditis, and two were sickle cell disease patients who presented with acute chest syndrome. Discussion and conclusion: The youngest patients seem to present milder forms of COVID-19 without the need for ICU treatment and with a shorter length of hospitalization. More severe evolutions were observed in teenagers, with, however, favorable outcomes. Given the context of closed schools and confinement, the infection of these children suggests intra-familial transmission that needs to be further assessed. This description might help to understand the intriguing differences in COVID-19 severity across age-classes.

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Section: Discussionmentioning

confidence: 99%

The Wide Spectrum of COVID-19 Clinical Presentation in Children

Nathan

Prévost

Sileo

et al. 2020

JCM

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“…In patients with SCD, hypoxia, dehydration, or acidosis due to respiratory infection may trigger a vaso-occlusive and hemolytic crisis and acute chest syndrome (ACS), with a high risk of thrombosis in pulmonary arteries. 27 Thus, measures to prevent and treat ACS early in the event of viral infection, require particular alertness by physicians treating infected patients. 28…”

Section: Discussionmentioning

confidence: 99%

A A Multicentre ICET-A Study of Confirmed SARS-CoV-2 Infection in Patients with Hemoglobinopathies: Preliminary Data from 10 Countries

Sanctis¹

2020

Mediterr J Hematol Infect Dis

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Objectives: This study aims to investigate, retrospectively, the epidemiological and clinical characteristics, laboratory results, radiologic findings and outcomes of novel coronavirus disease-19 (COVID-19) in patients with transfusion dependent β thalassemia (β-thalassemia major-TM), non-transfusion dependent β thalassemia (β-thalassemia intermedia -TI) and sickle cell disease (SCD). Design, setting: A total of 17 Centers, from 10 countries, following 9,499 patients with hemoglobinopathies participated in the survey. Main outcome measures: Clinical, laboratory and radiologic findings and outcomes of patients with COVID-19 were collected from medical records and summarized. Results: A total of 13 patients, 7 with TM, 3 with TI and 3 with SCD, with confirmed COVID-19, were identified from 6 Centers from different countries. The overall mean age of patients was 33.7±12.3 years (range:13-66); 9/13 (69.2%) patients were females. The commonest symptoms in the 10 symptomatic patients were: fever (80%), cough (70%), headache (60%), fatigue (60%), gastrointestinal symptoms (diarrhea /vomiting/abdominal pain; 50%), tachypnea/dyspnea (40%), and sore throat (40%). Six patients had pneumonia (unilateral, bilateral or multiple opacity) and 4 needed oxygen therapy. An oxygen saturation ≤ 93% was documented in 3 patients at diagnosis. 6/10 patients had an exacerbation of anemia (2 with SCD, associated with back and chest pain in 1 patient), and 3 (<30%) had a decreased absolute number of lymphocytes. Increased C-reactive protein and D-dimers were the most common laboratory findings (66.6 %). Conclusions: The clinical presentation for COVID-19 in patients with β-thalassemia and SCD varies. Patients with mild/ordinary COVID-19 infection appear to have clinical symptoms and laboratory findings common to other viral respiratory infections. One 30 year old TM female patient with diabetes and chronic kidney disease. For a better understanding of COVID-19 in patients with hemoglobinopathies, further epidemiologic and clinical studies in a larger cohort of patients are required.

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“…The clinical presentations, comorbidities, laboratory parameters, interventions, duration of admission and outcome of sickle cell disease patients with COVID-19 infection were reviewed in three different case series presentations by McCloskey et al, 2020, Hussain et al, 2020 and Heilbronner et al, 2020 [18,19,20]. The clinical presentations, comorbidities and laboratory parameters were compared with outcome of patients.…”

Section: Methodsmentioning

confidence: 99%

“…The management of acute chest syndrome in sickle cell anaemia is similar in that they both require oxygen therapy, antibiotic and exchange blood transfusion [16]. Despite the highly contagious nature of this COVID-19 and the immunosuppression in sickle cell disease, there were few studies done on COVID-19 in patients with sickle cell disease [18,19,20,21]. Most of these studies were case reports and case series that discussed the pattern of presentations and treatment modalities of COVID-19 in patients with sickle cell disease.…”

Section: Introductionmentioning

confidence: 99%

“…Most of these studies were case reports and case series that discussed the pattern of presentations and treatment modalities of COVID-19 in patients with sickle cell disease. None of them extensively discussed the prognostic factors of COVID-19 in patients with sickle cell disease, [19,20,21]. The knowledge of prognostic factors in patients with sickle cell disease with COVID-19 can help to predict the clinical outcome such as possibility of prolonged hospital admission, need for intensive care, worsening of comorbid clinical condition and mortality in this group of patient.…”

Section: Introductionmentioning

confidence: 99%

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Poor Prognostic Factors in Sickle Cell Disease Patients Infected with Covid-19 – Review of Literatures

Abiola¹,

Abdul²,

Muhammad³

2020

AJLM

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Sickle cell disease (SCD) is the co-inheritance of HbS with other abnormal haemoglobin. COVID-19 is a severe acute respiratory distress syndrome caused by coronavirus 2 infections. The immunosuppression and chronic inflammatory states in patients with SCD predispose them to severe form of COVID-19. The few case studies on sickle cell disease patients infected with COVID-19 mostly discuss the pattern of clinical presentations and laboratory changes in patients with SCD infected with COVID-19. This review of literature assesses the prognostic indicators in sickle cell disease patients infected with COVID 19 in three major case series. Some presenting symptoms and signs, presence of comorbidities and certain laboratory parameters were compared with poor outcome of patients. Poor clinical outcomes of patients in this review included: 1. Duration of admission of ≥10 days, 2. A week or more of intensive care unit admission, 3. Death of patient despite intervention while on admission, and 4. Deterioration in the presenting comorbid clinical condition. The presenting symptoms and signs, presence of comorbidities and certain laboratory parameters associated with these poor clinical outcomes were considered as poor prognostic factors. The presence of comorbidities, markedly elevated pro-inflammatory markers such as leukocytosis, IL-6, C-reactive proteins, marked elevated D-Dimer and high serum creatinine are poor prognostic factors in sickle cell disease patients with COVID-19 infection.

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Patients with sickle cell disease and suspected COVID‐19 in a paediatric intensive care unit

Cited by 40 publications

References 10 publications

The Wide Spectrum of COVID-19 Clinical Presentation in Children

The Wide Spectrum of COVID-19 Clinical Presentation in Children

A A Multicentre ICET-A Study of Confirmed SARS-CoV-2 Infection in Patients with Hemoglobinopathies: Preliminary Data from 10 Countries

Poor Prognostic Factors in Sickle Cell Disease Patients Infected with Covid-19 – Review of Literatures

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