Virginia Research Day 2021

Medical Resident Research Case Reports

22 Hyperhemolysis in the Setting Of Mixed-Autoimmune Hemolytic Anemia: A Rare Complication of COVID-19

Narula, S MD; Winkle S MD; Truitt, T MD; Brand, K MD; Khan, S MD; Helsley, D DO; Fujikawa, P DO; Shah, F MD; and Currie, M MD Corresponding author: Narula.sonya@yahoo.com

LewisGale Medical Center-Salem

Introduction: SARS-CoV-2 is a novel human pathogen known for its predilection for the respiratory system. However, syndromes extending outside the respiratory system are becoming increasingly apparent in the literature. Herein, we present a unique case in which a patient developed hyperhemolysis in the setting of mixed autoimmune hemolytic anemia secondary to SARS-CoV-2 Case Report: A 33-year old male with a past medical history of resolved immune thrombocytopenic purpura (ITP) presented to the hospital with symptoms of jaundice. Two weeks prior, he had a respiratory illness associated with loss of taste and smell that resolved seven days after onset. On admission, his Hgb was 12.5. Labs were significant for a bilirubin

Discussion: There have been 15 reported cases of SARS-CoV-2 associated autoimmune hemolytic anemia (AIHA). Patients with preexisting hematological abnormalities have a propensity to develop AIHA in the setting of the virus. The majority of the cases described in the literature were associated with warm autoimmune hemolytic anemia. Our patient tested positive for both warm and cold antibodies, which may have triggered hyperhemolysis. This case highlights the importance of early recognition of extra pulmonary manifestations after an infection of the virus, which may help practitioners anticipate poor outcomes and prevent further sequelae.

of 10 with a predominance of indirect bilirubin. Lab results showed LDH at 759, Haptoglobin <10, ferritin 4903, and the percent reticulocyte count was 2.33%, indicating hemolysis. A DAT was also positive for C3, IgG, anti-E, in addition to both warm and cold autoantibodies, which signified autoimmune hemolytic anemia. PCR was positive for COVID-19. Within two days of admission, his Hgb dropped to 5.9. A total of seven units of PRBC was required to achieve a Hgb of 6 in 48 hours. The patient was started on rituximab, IVIG, and methylprednisone. He rapidly deteriorated over the next several days, developing complications including multiorgan failure and DIC. He eventually went into cardiac arrest secondary to severe refractory anemia and perished.

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