Page 204 - 2020_11-Haematologica-web

Case Reports
Table 2. COVID-19 clinical features in SCD patients.
Patient Temp Cough Acute Mode of Hemoglobin Lymphocyte Platelet Maximum Transfused number >37.8°Cat pain respiratory concentration count count CRP on
Outcome
Full recovery following inpatient in hospital
Full recovery following inpatient in hospital Fullrecovery following inpatient in hospital Self-limiting illness, not admitted Self-limiting illness, not admitted Self-limiting illness, not admitted Self-limiting illness, not admitted Self-limiting illness, not admitted Diedofsevere respiratory failure and other co-existing morbidity
Full recovery following inpatient in hospital
presentation support nadir(g/L) nadir nadir (mg/L) (x10x9/L) (x10*9/L)
admission
N
Top up
N
N
N
N
N
N
N
Top up
1 Y
2 Y
3 Y
4 N
5 N
6 N
7 N
8 Y
9 Y
Y NNone-2.2
243 10.7
N N Nasal 75
canula
N Y None 96
N N None 91
N N None 103
N N None 122
N Y None 114
Y Y None 93
Y Y Nasalcanula 96
2.35 410 59.3
1 189 5.1
2.21 463 31.5
2.7 327 6.6
1.22 90 66.1
1.56 261 N/A
5.16 415 10.1
0.83 122 339
1.41 177 3.6
10Y Y
Y None 79
ding a history of brittle asthma and hyperhemolysis with multiple red cell alloantibodies, making it difficult to transfuse her. Escalation to ventilation was deemed unsuitable due to existing comorbidities.
Based on our small early cohort of 10 individuals with HbSS who have tested positive for COVID-19, patients seem to be experiencing a relatively mild course despite having significant associated comorbidities such as end stage renal failure, severe cerebral vasculopathy and recurrent painful episodes. Half were managed at home with regular telephone contact by the clinical team.
Our first (and so far) only fatality was in an individual of >50 years with poor pre-infection performance status and severe pre-existing lung disease, who had had admis- sions to intensive therapy unit (ITU) within the last 12 months, as well as multiple red cell alloantibodies and a previous history of severe delayed hemolytic transfusion reactions, which precluded transfusion. This patient had lymphopenia, thrombocytopenia and a high C-reactive protein (CRP), which have been identified as poor prog- nostic markers in patients without SCD.
Seven of 10 patients in this series were female, all patients were non-smokers and all but two were on a di-
Figure 1. Chest radiograph of patient 2 who was hypoxic on admission and received an early additive transfusion. This showed bilateral congestive changes with no additional pulmonary parenchymal pathology and was obtained on day 2 of admission.
2692
haematologica | 2020; 105(11)