Warm Autoimmune Hemolytic Anemia and Pure Red Cell Aplasia during a Severe COVID-19 B.1.1.7 Infection

Abstract

Warm autoimmune hemolytic anemia (AIHA) is a rare complication of COVID-19 infection. We report a case of warm AIHA in a patient with COVID-19 pneumonia treated with methylprednisolone and several red blood cell transfusions. Despite treatment of the warm AIHA, the patient’s reticulocyte count remained low, and his biochemical markers were suggestive of pure red cell aplasia, which was later attributed to a concurrent parvovirus B19 infection. This case highlights an unusual situation of two separate hematological processes caused by two separate and simultaneous viral infections.

Exacerbation of autoimmune hemolytic anemia associated with pure red cell aplasia after COVID-19: A case report

“…Some cases have been reported as coincidental infections by parvovirus-B19, known to cause PRCA by blocking p-antigens on erythroid precursors, resulting in proliferation and maturation arrest of erythroid precursors [ 18 ]. The case of AIHA and PRCA reported by Ghimire et al [ 14 ] was associated with double infections of COVID-19 and parvovirus-B19, and they suggested that the PRCA in their case was due to parvovirus-B19.…”

“…Although previous reports on COVID-19-associated PRCA that were resistant to PSL treatment and recovery after the administration of cyclosporine [ 15 ] or tacrolimus [ 13 ] were published, our case and the case by Karrat et al [ 12 ] showed a good response to PSL as shown in Table 2 . The case by Ghimire et al [ 14 ] also showed a response to dexamethasone. Appropriate selection of the treatment may differ from case to case, depending on the severity of COVID-19 or the host immunologic response of each patient.…”

“…Our case was associated with simultaneous occurrence of AIHA and PRCA after COVID-19. As per our search, simultaneous occurrence of AIHA and PRCA [ 14 , 15 ], or occurrence of PRCA [ 12 , 13 ] after COVID-19 have rarely been reported. Those reported patients including our case are summarized in Table 2 .…”

“…Previous cases [ 5 , 6 , [8] , [9] , [10] , [13] , [14] , [15] ] were mostly associated with severe COVID-19 infections, suggesting that the mechanisms of AIHA or PRCA may be related to the high inflammatory response evoked by COVID-19. However, the AIHA case reported by Liput et al [ 11 ] was induced by asymptomatic COVID-19 infection.…”

“…Currently, reports of AIHA occurrence after COVID-19 are being accumulated [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. However, reports of PRCA [ 12 , 13 ] or the simultaneous occurrence of AIHA and PRCA [ 14 , 15 ] have rarely been reported. Moreover, the manifestation of COVID-19 in our case was low-grade and only associated with mild fever.…”