Transient Sideroblastic Anemia Post-COVID-19 Infection

Abstract

A 57-year-old gentleman presented to the hospital with progressive fatigue and dyspnea on exertion three months after recovering from COVID-19. He was noted to have severe anemia with reticulocytopenia. After excluding vitamin deficiencies and heavy metal toxicities, a bone marrow aspirate and biopsy were performed, which showed erythroid predominant trilineage maturing hematopoiesis with 79% ring sideroblasts and no dysplasia. SF3B1 mutation was negative. He was diagnosed with sideroblastic anemia and became transfusion-dependent. He was treated with an erythropoiesis-stimulating agent and luspatercept with transient improvement in anemia. After 12 months of treatment, anemia spontaneously improved. Repeat bone marrow biopsy showed hypercellular marrow with 39% ringed sideroblasts. We suspect that this possibly was a delayed manifestation of COVID-19 infection.

COVID-19 in patients with anemia and haematological malignancies: risk factors, clinical guidelines, and emerging therapeutic approaches

“…Such mechanisms contribute to the formation of iron-rich mitochondrial complexes around erythroblast nuclei instead of the standard incorporation of iron into PPIX in the mitochondria [ 92 ]. It has then again been hypothesized that COVID-19 may induce an immune-mediated genetic defect in a hematopoietic clone, resulting in ineffective erythropoiesis and the development of RS cells [ 93 ]. Accordingly, COVID-19 likely induces a genetic change in new genes that cause SA [ 93 ].…”

“…It has then again been hypothesized that COVID-19 may induce an immune-mediated genetic defect in a hematopoietic clone, resulting in ineffective erythropoiesis and the development of RS cells [ 93 ]. Accordingly, COVID-19 likely induces a genetic change in new genes that cause SA [ 93 ]. In addition, SARS-CoV-2 interacts with Hb molecules through a cluster of differentiation 147 (CD147), CD2b, and other receptors commonly found on erythrocytes and other Hb cells, leading to Hb denaturation [ 94 ].…”