Hematol Oncol Stem Cell Ther . Cold Agglutinin Disease and Autoimmune Hemolytic Anemia With Pulmonary Embolism as a Presentation of COVID-19 Infection

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Hematol Oncol Stem Cell Ther


. 2020 Jul 6;S1658-3876(20)30116-3.
doi: 10.1016/j.hemonc.2020.06.005. Online ahead of print.
Cold Agglutinin Disease and Autoimmune Hemolytic Anemia With Pulmonary Embolism as a Presentation of COVID-19 Infection


Neha R Patil ¹ , Erica S Herc ² , Marian Girgis ³



Affiliations

• PMID: 32645300
• DOI: 10.1016/j.hemonc.2020.06.005

Abstract

Background: Lymphopenia, thrombocytopenia, and elevated D-dimer and ferritin levels are frequently reported in patients with severe coronavirus disease 2019 (COVID-19). Here we report a case of cold agglutinin disease (CAD), autoimmune hemolytic anemia (AIHA), and pulmonary embolism as a presentation of COVID-19 infection.
Case report: A 51-year-old African-American woman presented to the emergency room with fever and shortness of breath. She was tachycardic, febrile, and had an oxygen saturation of 88% on room air. Laboratory studies showed hemoglobin (Hb) 5.1 g/dL, D-dimer 4.55 ?g/mL, and C-reactive protein 12.3 mg/dL. Computed tomography scan of the chest showed acute pulmonary embolism involving the bilateral lower lobe segmental branches. Her influenza test was negative, but her SARS-CoV-2 test returned positive. Due to severe anemia, she was not started on any anticoagulation. Haptoglobin was low. Direct antiglobulin test returned positive for anticomplement and negative for anti-immunoglobulin G. Cold agglutinin titer was 80. Mycoplasma, Epstein-Barr virus, parvovirus, human immunodeficiency viruses, and acute hepatitis screen were negative. Abdominal and pelvic computed tomography showed a normal liver and spleen without lymphadenopathy. Peripheral blood smear showed red blood cell agglutination. On Day 2, she became hypoxic requiring 6 L oxygen. Since her Hb remained stable, she was started on low-intensity unfractionated heparin. Inflammatory markers subsequently improved and she was weaned off oxygen. Her Hb remained stable at 9 g/dL and she was discharged home. After 2 weeks, her Hb increased to 11 g/dL.
Conclusion: As exemplified in this case report, COVID-19 infection can lead to thromboembolism, CAD, and AIHA and it should be recognized as a potential etiology to such rare diseases.

Keywords: Anemia; Autoimmune; COVID-19; Cold agglutinin disease; Hemolytic; Pulmonary embolism.