SARS CoV 2 infection in chronic myelogenous leukemia: Severe hematological presentation.

Abstract

Infection with SARS-CoV-2, the cause of coronavirus infectious disease-19 (COVID-19), has caused a pandemic. Few data are available about the risk of COVID-19 infection in persons with hematological cancer, but controversy whether these persons have the same clinical signs and outcomes. We describe a case of life-threatening COVID-19 infection complicated by severe anemia in patients affected also by chronic myelogenous leukemia. The screening for RBC antibodies and the direct antiglobulin test (DAT) turned positive. The identification of the antibodies, showed the presence of an alloantibody with anti-Lewis b specificity, which was reactive at room temperature, in the anti-human globulin phase (AGH) and with papain-treated red blood cells. At the same time hemophagocytic lymphohistiocytosis (HLH), on the basis of major laboratory findings including hyperferritnemia, increase of triglicerides levels and according to the HLH score was suspected. Patients received antiviral therapy, steroids and intravenous immunoglobulins. Hemolysis resolved and ferritin dramatically decreased after administration of Ig and a Afull recovery was achieved after viral infection resolution.This case highlights the novel and multifaceted hematological findings during sever COVID 19 infection. COVID 19-related pneumonia is mediated by hyper activation of effector T cells and excessive production of inflammatory cytokines, such as IL-6, IL-1, interferon-gamma, and TNF. This inflammatory process called "cytokine storm" is a life-threatening complication of COVID 19 infection. In this case severe immunohematological consequences are reported for the first time and recognition of this complications are probably underestimated.

• Authors: Federica Sorà, Patrizia Chiusolo, Luca Laurenti, Idanna Innocenti, Francesco Autore, Eleonora Alma, Marcello Viscovo, Domernico Fusco, Maddalena Maresca, Mario Tumbarello, Simona Sica
• Journal: Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis (Transfus Apher Sci) Vol. 59 Issue 6 Pg. 102881 (Dec 2020) ISSN: 1473-0502 [Print] England
• PMID: 32828694 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2020. Published by Elsevier Ltd.

Chemical References

• Cytokines

Topics

• COVID-19 (blood, diagnostic imaging, therapy)
• Cytokines (blood)
• Humans
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (blood, diagnostic imaging, therapy)
• Lymphohistiocytosis, Hemophagocytic (blood, diagnostic imaging, therapy)
• Male
• Middle Aged
• SARS-CoV-2 (metabolism)