Successful Management of Sickle Cell Disease Patient with Covid-19 Infection in a Low Resource Setting: Case Study

Abstract

Background: Sickle cell disease (SCD) patients have greater susceptibility to infections, they are reckoned to be vulnerable patients during the current COVID-19 pandemic. SCD patients are commonly affected by pulmonary complications such as acute chest syndrome (ACS), pulmonary embolism (PE) and pneumonia that contribute significantly to mortality risks.
 Aim: The study was aimed at showing the impact of SARS-COV viral pandemic on SCD patients.
 Presentation of Case: A 42-year-old male known sickle cell disease patient, who presented with a 5 days’ history of chest pain and difficulty in breathing with a pain score of 8/10. Pain was said to be localized and, subside on the ingestion of analgesics (Tab DF118/60mg and PCM 1000mg) with no known aggravating factor, but there was associated history of difficulty in breathing. The patient was being managed as a case of vaso-occlusive crises R/O acute chest syndrome, and was commenced on adequate hydration, oxygen saturation was between 95-85%. On examination, respiratory rate was 20 cycles per minute, pulse rate – 96 beats/minute, BP and chest examination were essentially normal. CBC showed the Packed Cell Volume of 31%, White Blood Cells 15.04 x 109/L, Neutrophils 7.51x103/µL Lymphocyte 6.50 x103/µL, Monocyte 0.76 x103/µL Eosinophils 0.20x103/µL, Basophils 0.05x103/µL, Platelet 358. The electrolytes (Na-135 mmol/L, K 3.5mmol/L, HCO3-20), urea -10 mmol/L and creatinine (88mmol/L) were normal, the chest x-ray showed cardiomegaly but the lung fields were clear. The patient was administered ceftriaxone (prophylactic antibiotics – 1 g daily). The patient tested positive to COVID-19 and was immediately transferred to the isolation centre for proper management. He was commenced on oral medication, azithromycin, dexamethasone, ivermectine, amoxicillin/clavulanic acid, vitamin C, clexane and the analgesic was changed to paracetamol and dihydrocodeine to alternate 3 hourly with accordance to the national guidelines. In addition, he was administered subcutaneous enoxaparin due to the hypercoagulability state of SCD. The patient’s health status improved within 24hours of commencement of the above medications and remained stable all through the period of isolation and a repeat covid-19 test was done 15 days of admission using and reverse transcriptase PCR and was discharged home according to the National protocol.
 Conclusion: Studies and clinical trials are essential to evaluate effective diagnostic and management options for SCD patients and other high-risk conditions like diabetes hypertension, cancer patients and so on that are associated with fatal complications when infected with COVID-19 and similar diseases.

Impact of the SARS-CoV-2 infection in individuals with sickle cell disease: an integrative review

“…Contrary to this, some authors advocate that sickle cell disease confers an increased risk for severe COVID-19 ( 41 , 43 , 51 , 52 , 54 , 61 , 63 , 65 , 66 , 68 , 69 , 88 , 94 , 95 , 98 , 111 , 112 ). More than one algorithm conceived to calculate the risk of different populations developing complications from COVID-19 pointed to sickle cell disease as a risk factor ( 48 , 73 , 88 , 100 ) supporting, for example, the indication of the prophylactic use of anticoagulants for this group ( 53 , 56 , 65 , 84 ).…”

“…In some cases, even individuals with sickle cell trait are considered to be at risk ( 40 , 110 , 112 , 119 ). The immunosuppressive state, increased risk of sepsis, endothelial dysfunction, and cardiovascular impairment are some of the characteristics of sickle cell disease that may explain these outcomes ( 2 , 51 , 54 , 61 , 63 , 66 , 68 ). The fact that COVID-19 acts as a trigger for the occurrence of sickle cell complications, which are events that are associated with high mortality, may also contribute to this scenario, as will be discussed in the next section.…”