Warm Autoimmune Hemolytic Anemia Comorbidity and COVID-19 Infection: A Case Report

Israel Gomez; Sarah Turkel; Payman Nasr

doi:10.29074/ascls.2022003212

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Figure 1.
The chronological comparison of the laboratory results for the relative reticulocyte percentage, lactate dehydrogenase (LDH), and total bilirubin (T. Bili), with respect to the hemoglobin values since the onset of the first hemolytic episode. (A) Hemoglobin versus relative reticulocyte percentage, (B) hemoglobin versus LDH, (C) hemoglobin versus total bilirubin. The arrows indicate relapses, whereas the straight vertical lines show each treatment regimen.

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Table 1.

Hemoglobin, total bilirubin, and treatment notes

Date	Hgb (mg/dL)	T. Bili (mg/dL)	Fibrinogen (mg/dL)	D-Dimer (ug/ml)	Treatment Notes
12/11/20	nt	nt	nt	nt	COVID-19 test positive
12/14/20	10.1	2.0	nt	nt	Pancytopenia; elevated hemolysis indices
12/19/20	6.8	3.1	505	0.96	Hospital admission
12/20/20	5.6	5.0	454	>20	1 unit (Rh, Kell matched) caused exacerbation of hemolysis triggered by transfusion reaction; dexamethasone; enoxaparin
12/21/20	3.9	4.7	433	>20	1 unit phenotypically matched, irradiated, washed, and infused over 8 hours; dexamethasone; enoxaparin
12/22/20	5.2	2.8	nt	4.72	No transfusion; dexamethasone; IVIG; rivaroxaban
12/23/20	4.9	2.5	419	2.02	No transfusion; dexamethasone; EPO; IVIG; rivaroxaban
12/24/20	4.5	4.4	nt	1.68	1 unit phenotypically matched, irradiated, and washed infused over 8 hours; EPO; IVIG; rivaroxaban
12/25/20	4.4	5.3	504	1.88	1 unit phenotypically matched, irradiated, and washed infused over 8 hours; prednisone; EPO; rivaroxaban
12/26/20	4.0	4.5	515	1.59	1 unit phenotypically matched, irradiated, and washed infused over 8 hours; prednisone; EPO; rivaroxaban
12/27/20	4.0	4.5	536	1.27	1.5 units phenotypically matched, irradiated, and washed infused over 8 hours; prednisone; EPO; rivaroxaban; discontinued participation in the clinical study
12/28/20	6.1	4.4	518	1.04	2.5 units phenotypically matched, irradiated, and washed infused at a slow rate; prednisone; EPO; rivaroxaban
12/29/20	7.3	2.5	nt	nt	1 unit phenotypically matched, irradiated, and washed infused over 8 hours; prednisone; EPO; rivaroxaban
12/30/20	7.3	2.5	nt	2.21	Prednisone; EPO; rivaroxaban
12/31/20	7.4	2.4	nt	nt	Prednisone; EPO; COVID-19 PCR test negative; rivaroxaban
1/1/21	8.1	2.4	nt	1.49	Discharged; maintained on 50 mg daily prednisone

Patient’s hemoglobin, T. Bili, fibrinogen, D-dimer, and daily treatment notes following COVID-19 infection and hospitalization are shown in a chronological order. Dexamethasone, 40 mg; enoxaparin, 40 mg; EPO, epoetin alfa 40 000 units/mL; Hgb, hemoglobin; IVIG, immune globulin 500 mg/kg infusion; nt, not tested; PCR, polymerase chain reaction; prednisone, 110 mg; rivaroxaban, 10 mg; T. Bili, total bilirubin.