A 46-year-old woman who tested positive for the new coronavirus also was diagnosed with cold agglutinin disease (CAD), a case study reported.
The link between the COVID-19-causing virus and CAD needs to be monitored, scientists said.
The study, “Cold Agglutinin Autoimmune Hemolytic Anemia Associated with Novel Coronavirus (COVID‐19),” was published in the British Journal of Haematology.
In people with CAD, exposure to cold stimulates the formation of autoantibodies called cold agglutinins that attack red blood cells, inducing their degradation and causing anemia.
CAD affects mostly older adults and can present as a primary disease of unknown origin, or be caused by underlying health issues viral infections, including the Epstein Barr virus, rubella virus, and influenza.
How viruses cause CAD remains unknown, but research has pointed to the activation of inflammatory processes. Also unknown is the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus that causes the pro-inflammatory infection COVID-19, on CAD.
In this report researchers at Reading Hospital in Pennsylvania shared the case of a 46-year-old woman admitted with fever — 38.2 C (100.8 F) — accelerated heart rate at 107 beats per minute, and abnormal breathing rate at 29 breaths per minute. Her medical history included immune thrombocytopenic purpura — a blood disorder characterized by low levels of platelets — spleen removal, anemia, asthma, shortness of breath, muscle aches, and lethargy.
Blood work six months before hospital admission was normal. However, hemoglobin levels were low — 5.3 g/deciliter (normal range in women is 12.1 to 15.1 g/dL) — white blood cell count was elevated (consistent with infection), as was her reticulocyte count, an indication of high red blood cells breakdown.
The patient’s total bilirubin levels were elevated, which, together with results of a Coombs test, was consistent with a CAD diagnosis. Likewise, lactate dehydrogenase (LDH) levels were elevated, suggesting anemia, and haptoglobin levels were undetectable. Also, a blood smear test found aglutination of red blood cells, also in line with CAD.
While most viral tests were negative, she tested positive for SARS-CoV-2.
Despite a blood transfusion and nasal oxygen supplementation at the maximum setting, the patient died from cardiac arrest immediately before she could be put on a ventilator.
Additional treatment could not be considered due to her rapid deterioration and eventual death, which occurred less than 24 hours after hospital admission.
“Ongoing surveillance will be required for further potential associations of COVID-19 and [CAD],” the scientists wrote.
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