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Case Reports
sease modifying treatments, such as regular a blood transfusion programme or hydroxycarbamide. These demographic features may have contributed to the mild clinical course in all but one patient.
SCD is mentioned in the Public Health England list of conditions which should prompt individuals to be shield- ed from infection, by rigorous self-isolation. Our series shows that patients with SCD can have a relatively mild course with COVID-19. It is difficult to speculate why this might be the case, and it may be postulated that most of our patients were already on some form of di- sease modification, which may have helped with the host response. It is unclear whether hyposplenism has played a role in the apparent lack of a hyperimmune syndrome and this is likely to be an area of research in the future. The one patient who died was in a poor prognostic group, based on risk factors identified in the general pop- ulation. So far, we have seen no children with COVID-19 and SCD, suggesting that this may be a mild condition in children with SCD, as has been found in the general po- pulation. It is not entirely clear why more women are represented in this group. It is possible that with time, this ratio may become more skewed to the male sex. The relatively low case fatality is evidence that affected indi- viduals should not be excluded from potentially lifesa- ving measures including respiratory support and artificial ventilation, particularly as our well-studied cohort have a median survival of 67 years.8
Subarna Chakravorty, Giselle Padmore-Payne, Fester Ike, Virginia Tshibangu, Charlotte Graham, David Rees and Sara Stuart-Smith
King's College Hospital, London, UK
Correspondence:
SUBARNA CHAKRAVORTY - subarna.chakravorty@nhs.net
doi:10.3324/haematol.2020.254250
References
1. WorldHealthOrganisation.Coronavirusdisease(COVID-19)situa- tion summary. 2020 27/3/2020. Available from: https:// experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b91 25cd.
2. Public Health England. Total UK COVID-19 cases update 2020 27/3/20. Available from: https://www.arcgis.com/apps/opsdash- board/index.html#/f94c3c90da5b4e9f9a0b19484dd4bb14.
3. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortal- ity of adult inpatients with COVID-19 in Wuhan, China: a retro- spective cohort study. Lancet. 2020;395(10229):1054-1062.
4. ShiY,YuX,ZhaoH,WangH,ZhaoR,ShengJ.Hostsusceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan. Crit Care. 2020;24(1):108.
5. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
6. Piel FB, Steinberg MH, Rees DC. Sickle cell disease. N Engl J Med. 2017;376(16):1561-1573.
7. PublicHealthEngland.Guidanceandstandardoperatingprocedure COVID-19 virus testing in NHS laboratories. 2020. https://www.england.nhs.uk/coronavirus/publication/guidance- and-standard-operating-procedure-covid-19-virus-testing-in-nhs- laboratories/
8. Gardner K, Douiri A, Drasar E, et al. Survival in adults with sickle cell disease in a high-income setting. Blood. 2016;128(10):1436- 1438.
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