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Bazdar S, Bloemsma LD, Baalbaki N, Blankestijn JM, Cornelissen MEB, Beijers RJHCG, Sondermeijer BM, van Wijck Y, Downward GS, Maitland-van der Zee AH. Hemoglobin and Its Relationship with Fatigue in Long-COVID Patients Three to Six Months after SARS-CoV-2 Infection. Biomedicines 2024; 12:1234. [PMID: 38927441 PMCID: PMC11201257 DOI: 10.3390/biomedicines12061234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Background: While some long-term effects of COVID-19 are respiratory in nature, a non-respiratory effect gaining attention has been a decline in hemoglobin, potentially mediated by inflammatory processes. In this study, we examined the correlations between hemoglobin levels and inflammatory biomarkers and evaluated the association between hemoglobin and fatigue in a cohort of Long-COVID patients. Methods: This prospective cohort study in the Netherlands evaluated 95 (mostly hospitalized) patients, aged 40-65 years, 3-6 months post SARS-CoV-2 infection, examining their venous hemoglobin concentration, anemia (hemoglobin < 7.5 mmol/L in women and <8.5 mmol/L in men), inflammatory blood biomarkers, average FSS (Fatigue Severity Score), demographics, and clinical features. Follow-up hemoglobin was compared against hemoglobin during acute infection. Spearman correlation was used for assessing the relationship between hemoglobin concentrations and inflammatory biomarkers, and the association between hemoglobin and fatigue was examined using logistic regression. Results: In total, 11 (16.4%) participants were suffering from anemia 3-6 months after SARS-CoV-2 infection. The mean hemoglobin value increased by 0.3 mmol/L 3-6 months after infection compared to the hemoglobin during the acute phase (p-value = 0.003). Whilst logistic regression showed that a 1 mmol/L greater increase in hemoglobin is related to a decrease in experiencing fatigue in Long-COVID patients (adjusted OR 0.38 [95%CI 0.13-1.09]), we observed no correlations between hemoglobin and any of the inflammatory biomarkers examined. Conclusion: Our results indicate that hemoglobin impairment might play a role in developing Long-COVID fatigue. Further investigation is necessary to identify the precise mechanism causing hemoglobin alteration in these patients.
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Affiliation(s)
- Somayeh Bazdar
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Lizan D. Bloemsma
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Nadia Baalbaki
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Jelle M. Blankestijn
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Merel E. B. Cornelissen
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Rosanne J. H. C. G. Beijers
- Department of Respiratory Medicine, Nutrim Institute of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6202 AZ Maastricht, The Netherlands;
| | | | - Yolanda van Wijck
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - George S. Downward
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 CL Utrecht, The Netherlands;
- Department of Global Public Health & Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Anke H. Maitland-van der Zee
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
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2
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Kosenko E, Tikhonova L, Alilova G, Montoliu C. Erythrocytes Functionality in SARS-CoV-2 Infection: Potential Link with Alzheimer's Disease. Int J Mol Sci 2023; 24:5739. [PMID: 36982809 PMCID: PMC10051442 DOI: 10.3390/ijms24065739] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a rapidly spreading acute respiratory infection caused by SARS-CoV-2. The pathogenesis of the disease remains unclear. Recently, several hypotheses have emerged to explain the mechanism of interaction between SARS-CoV-2 and erythrocytes, and its negative effect on the oxygen-transport function that depends on erythrocyte metabolism, which is responsible for hemoglobin-oxygen affinity (Hb-O2 affinity). In clinical settings, the modulators of the Hb-O2 affinity are not currently measured to assess tissue oxygenation, thereby providing inadequate evaluation of erythrocyte dysfunction in the integrated oxygen-transport system. To discover more about hypoxemia/hypoxia in COVID-19 patients, this review highlights the need for further investigation of the relationship between biochemical aberrations in erythrocytes and oxygen-transport efficiency. Furthermore, patients with severe COVID-19 experience symptoms similar to Alzheimer's, suggesting that their brains have been altered in ways that increase the likelihood of Alzheimer's. Mindful of the partly assessed role of structural, metabolic abnormalities that underlie erythrocyte dysfunction in the pathophysiology of Alzheimer's disease (AD), we further summarize the available data showing that COVID-19 neurocognitive impairments most probably share similar patterns with known mechanisms of brain dysfunctions in AD. Identification of parameters responsible for erythrocyte function that vary under SARS-CoV-2 may contribute to the search for additional components of progressive and irreversible failure in the integrated oxygen-transport system leading to tissue hypoperfusion. This is particularly relevant for the older generation who experience age-related disorders of erythrocyte metabolism and are prone to AD, and provide an opportunity for new personalized therapies to control this deadly infection.
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Affiliation(s)
- Elena Kosenko
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Lyudmila Tikhonova
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Gubidat Alilova
- Institute of Theoretical and Experimental Biophysics of Russian Academy of Sciences, 142290 Pushchino, Russia
| | - Carmina Montoliu
- Hospital Clinico Research Foundation, INCLIVA Health Research Institute, 46010 Valencia, Spain
- Pathology Department, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
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3
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Malakah MA, Baghlaf BA, Alsulami SE. Co-Occurring Hemolysis and Methemoglobinemia After COVID-19 Infection in Patient With G6PD Deficiency. Cureus 2023; 15:e35020. [PMID: 36938163 PMCID: PMC10022702 DOI: 10.7759/cureus.35020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
Hemolytic anemia and methemoglobinemia are known complications in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. They can be elicited by various oxidative stressors. Here we report a case of an adult with the first episode of G6PD deficiency associated hemolysis and methemoglobinemia after acquiring COVID-19 infection, who had no recent exposure to oxidative drugs or fava beans. A 52-year-old gentleman known to have myocardial bridging on aspirin and beta-blocker, with no other medical illnesses, developed anemia symptoms, jaundice, and hypoxia after contracting COVID-19 infection. Further laboratory work revealed non-immune hemolytic anemia, methemoglobinemia, and a positive G6PD screen test. He was treated conservatively with a blood transfusion, and his oxygen saturation improved thereafter. With the widespread COVID-19 infection and its morbidity worldwide, it is crucial to consider methemoglobinemia in the differential diagnosis of hypoxia. Testing for G6PD is an essential next step in such cases, as starting methylene blue in G6PD deficiency can worsen hemolysis. Apart from COVID-19, there is no other identified trigger for the acute event in this patient. It is not known whether COVID-19 infection alone is enough to result in G6PD deficiency-associated hemolysis and methemoglobinemia simultaneously.
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Affiliation(s)
- Manar A Malakah
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Bayan A Baghlaf
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Samaher E Alsulami
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
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4
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Parajuli B, Shrestha S, Lamichhane S, Subedi S, KC S. Methemoglobinemia due to Hemolysis Secondary to Infection in a Child: A Case Report. JNMA J Nepal Med Assoc 2022; 60:906-908. [PMID: 36705148 PMCID: PMC9924921 DOI: 10.31729/jnma.7874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Indexed: 11/06/2022] Open
Abstract
Methemoglobinemia is a rare condition characterised by hypoxic state manifesting as headache, nausea, fatigue, and confusion. We report a 2-year-old boy presenting with fever and cough for 7 days with an episode of hypoxia as the saturation declined and did not improve on face mask oxygenation. On further evaluation, acute intravascular hemolysis was established following decreased haemoglobin level, increased levels of lactate dehydrogenase, and unconjugated bilirubin in the setting of documented infection. Assessment of arterial blood gas showed a significantly raised saturation gap and detection of methemoglobin confirmed the diagnosis. He was managed conservatively with packed red blood cells transfusion following which hypoxia was corrected. Methemoglobinemia as a result of hemolysis can be a non-cardio-respiratory cause of hypoxia and inciting aetiology needs to be addressed. Keywords case reports; hemolysis; hypoxia; infection; methemoglobinemia.
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Affiliation(s)
- Biraj Parajuli
- Department of Pediatrics, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal,Correspondence: Dr Biraj Parajuli, Department of Pediatrics, Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal. , Phone: +977-9841315994
| | - Swikriti Shrestha
- Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal
| | | | - Subash Subedi
- Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Sujata KC
- Chitwan Medical College Teaching Hospital, Bharatpur, Chitwan, Nepal
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5
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Cantrell C, Costers V, Wilson CC, Dudek CJ, Arnold JK. Refractory Methemoglobinemia Secondary to Topical Dapsone With Subsequent Autoimmune Hemolytic Anemia. Cureus 2022; 14:e28811. [PMID: 36225525 PMCID: PMC9534637 DOI: 10.7759/cureus.28811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
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Fimognari FL, Bambara V, Scarpino P, Cuccurullo O, Ricchio R, Iorio C, Rizzo M. Methemoglobinemia and acute hemolysis induced by high intravenous doses of vitamin C in a COVID-19 patient with unrecognized glucose-6- phosphate-dehydrogenase deficiency. GERIATRIC CARE 2022. [DOI: 10.4081/gc.2022.10286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
In glucose-6-phosphate-dehydrogenase deficiency (favism), exposure to oxidant agents can trigger hemolytic crises. The intravenous administration of very high doses of vitamin C was proposed as a treatment for severe coronavirus disease 2019 (COVID-19) pneumonia. Unlike low vitamin C doses, very high doses (>6 gr daily) can promote H2O2 formation, oxidation of hemoglobin to methemoglobin and, eventually, hemolytic anemia in patients with favism. We here describe the case of a 77-year old man hospitalized for severe COVID-19 pneumonia and treated with a mean daily dose of 9.5 gr of intravenous vitamin C during the first 6 days. He developed methemoglobinemia and hemolytic anemia, which improved after interruption of vitamin C treatment. Previously unrecognized glucose- 6-phophate-dehydrogenase deficiency was diagnosed. This first case of vitamin Cinduced hemolytic anemia in a COVID-19 patient indicates the need of a screening for glucose-6-phosphate-dehydrogenase deficiency before treatment with very high vitamin C doses or for long period.
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7
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Al-kuraishy HM, Al-Gareeb AI, Kaushik A, Kujawska M, Batiha GES. Hemolytic anemia in COVID-19. Ann Hematol 2022; 101:1887-1895. [PMID: 35802164 PMCID: PMC9263052 DOI: 10.1007/s00277-022-04907-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/25/2022] [Indexed: 12/15/2022]
Abstract
COVID-19 is a global pandemic triggered by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 entry point involves the interaction with angiotensin-converting enzyme 2 (ACE2) receptor, CD147, and erythrocyte Band3 protein. Hemolytic anemia has been linked to COVID-19 through induction of autoimmune hemolytic anemia (AIHA) caused by the formation of autoantibodies (auto-Abs) or directly through CD147 or erythrocyte Band3 protein-mediated erythrocyte injury. Here, we aim to provide a comprehensive view of the potential mechanisms contributing to hemolytic anemia during the SARS-CoV-2 infection. Taken together, data discussed here highlight that SARS-CoV-2 infection may lead to hemolytic anemia directly through cytopathic injury or indirectly through induction of auto-Abs. Thus, as SARS-CoV-2-induced hemolytic anemia is increasingly associated with COVID-19, early detection and management of this condition may prevent the poor prognostic outcomes in COVID-19 patients. Moreover, since hemolytic exacerbations may occur upon medicines for COVID-19 treatment and anti-SARS-CoV-2 vaccination, continued monitoring for complications is also required. Given that, intelligent nanosystems offer tools for broad-spectrum testing and early diagnosis of the infection, even at point-of-care sites.
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Affiliation(s)
- Hayder M. Al-kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, M.B.Ch.B, FRCP, Baghdad, Iraq
| | - Ali I. Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, M.B.Ch.B, FRCP, Baghdad, Iraq
| | - Ajeet Kaushik
- NanoBioTech Laboratory, Department of Environmental Engineering, Florida Polytechnic University, Lakeland, FL 33805-8531 USA
| | - Małgorzata Kujawska
- Department of Toxicology, Faculty of Pharmacy, Poznan University of Medical Sciences, Dojazd 30, 60-631 Poznań, Poland
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour 22511, Al Beheira, Egypt
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8
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Chhabria B, Arora N, Chahal S, Kumar Pannu A, Muthu V, Kumar M. SARS-CoV-2 infection, pulse oximetry, and interpretive caveats. Trop Doct 2022; 52:593-595. [PMID: 35775134 PMCID: PMC9253519 DOI: 10.1177/00494755221094983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypoxaemia in COVID-19 does not necessarily imply COVID pneumonia or post-COVID
lung fibrosis, and the caveats of finger pulse oximetry should be remembered.
Drug-induced methaemoglobinemia should be considered in individuals with
unexplained cyanosis, refractory hypoxaemia, or the presence of a saturation
gap. Here, we share our recent encounter of ‘spurious hypoxia’ in a patient with
COVID-19 and methaemoglobinemia.
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Affiliation(s)
| | | | | | | | | | - Mohan Kumar
- Mohan Kumar H, Assistant Professor,
Department of Internal Medicine, Post Graduate Institute of Medical Education
and Research, Chandigarh, India.
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Dixit VA, Blumberger J, Vyas SK. Methemoglobin formation in mutant hemoglobin α chains: electron transfer parameters and rates. Biophys J 2021; 120:3807-3819. [PMID: 34265263 DOI: 10.1016/j.bpj.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/06/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022] Open
Abstract
Hemoglobin-mediated transport of dioxygen (O2) critically depends on the stability of the reduced (Fe2+) form of the heme cofactors. Some protein mutations stabilize the oxidized (Fe3+) state (methemoglobin, Hb M), causing methemoglobinemia, and can be lethal above 30%. The majority of the analyses of factors influencing Hb oxidation are retrospective and give insights only for inner-sphere mutations of heme (His58, His87). Herein, we report the first all-atom molecular dynamics simulations on both redox states and calculations of the Marcus electron transfer (ET) parameters for the α chain Hb oxidation and reduction rates for Hb M. The Hb wild-type (WT) and most of the studied α chain variants maintain globin structure except the Hb M Iwate (H87Y). The mutants forming Hb M tend to have lower redox potentials and thus stabilize the oxidized (Fe3+) state (in particular, the Hb Miyagi variant with K61E mutation). Solvent reorganization (λsolv 73-96%) makes major contributions to reorganization free energy, whereas protein reorganization (λprot) accounts for 27-30% except for the Miyagi and J-Buda variants (λprot ∼4%). Analysis of heme-solvent H-bonding interactions among variants provide insights into the role of Lys61 residue in stabilizing the Fe2+ state. Semiclassical Marcus ET theory-based calculations predict experimental kET for the Cyt b5-Hb complex and provide insights into relative reduction rates for Hb M in Hb variants. Thus, our methodology provides a rationale for the effect of mutations on the structure, stability, and Hb oxidation reduction rates and has potential for identification of mutations that result in methemoglobinemia.
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Affiliation(s)
- Vaibhav A Dixit
- Department of Pharmacy, Birla Institute of Technology and Sciences Pilani (BITS-Pilani), Rajasthan, India.
| | - Jochen Blumberger
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - Shivam Kumar Vyas
- Department of Pharmacy, Birla Institute of Technology and Sciences Pilani (BITS-Pilani), Rajasthan, India
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Huda Z, Jahangir A, Sahra S, Rafay Khan Niazi M, Anwar S, Glaser A, Jahangir A. A Case of COVID-19-Associated Autoimmune Hemolytic Anemia With Hyperferritinemia in an Immunocompetent Host. Cureus 2021; 13:e16078. [PMID: 34345558 PMCID: PMC8324606 DOI: 10.7759/cureus.16078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 01/02/2023] Open
Abstract
We report an interesting case of a middle-aged gentleman who presented with diabetic ketoacidosis (DKA) and tested polymerase chain reaction (PCR) positive for COVID-19 infection. His hospital stay was complicated by acute kidney injury, hematuria, and normocytic anemia. Initial chest x-ray demonstrated bibasilar opacities. D-dimer and C-reactive protein were elevated. During his hospital stay, his hemoglobin decreased from 13.4 g/dL to 9 g/dL, and further workup demonstrated ferritin of 49,081 ng/mL with lactate dehydrogenase of 1665 U/L. He was treated with prednisone and folic acid for autoimmune hemolytic anemia (AIHA). Ferritin was downtrended, and hemoglobin stabilized. As demonstrated by this case report and prior literature review, COVID-19 infection can be associated with AIHA.
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Affiliation(s)
- Zoha Huda
- Medicine, The City University of New York (CUNY) School of Medicine, New York, USA
| | - Abdullah Jahangir
- Internal Medicine, Staten Island University Hospital, Northwell Health, New York, USA
| | - Syeda Sahra
- Internal Medicine, Northwell Health, New York, USA
| | | | - Shamsuddin Anwar
- Internal Medicine, Staten Island University Hospital, Northwell Health, New York, USA
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Gille T, Sesé L, Aubourg E, Fabre EE, Cymbalista F, Ratnam KC, Valeyre D, Nunes H, Richalet JP, Planès C. The Affinity of Hemoglobin for Oxygen Is Not Altered During COVID-19. Front Physiol 2021; 12:578708. [PMID: 33912067 PMCID: PMC8072381 DOI: 10.3389/fphys.2021.578708] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background: A computational proteomic analysis suggested that SARS-CoV-2 might bind to hemoglobin (Hb). The authors hypothesized that this phenomenon could result in a decreased oxygen (O2) binding and lead to hemolytic anemia as well. The aim of this work was to investigate whether the affinity of Hb for O2 was altered during COVID-19. Methods: In this retrospective, observational, single-center study, the blood gas analyses of 100 COVID-19 patients were compared to those of 100 non-COVID-19 patients. Fifty-five patients with carboxyhemoglobin (HbCO) ≥8% and 30 with sickle cell disease (SCD) were also included ("positive controls" with abnormal Hb affinity). P50 was corrected for body temperature, pH, and PCO2. Results: Patients did not differ statistically for age or sex ratio in COVID-19 and non-COVID-19 groups. Median P50 at baseline was 26 mmHg [25.2-26.8] vs. 25.9 mmHg [24-27.3], respectively (p = 0.42). As expected, P50 was 22.5 mmHg [21.6-23.8] in the high HbCO group and 29.3 mmHg [27-31.5] in the SCD group (p < 0.0001). Whatever the disease severity, samples from COVID-19 to non-COVID-19 groups were distributed on the standard O2-Hb dissociation curve. When considering the time-course of P50 between days 1 and 18 in both groups, no significant difference was observed. Median Hb concentration at baseline was 14 g.dl-1 [12.6-15.2] in the COVID-19 group vs. 13.2 g.dl-1 [11.4-14.7] in the non-COVID-19 group (p = 0.006). Among the 24 COVID-19 patients displaying anemia, none of them exhibited obvious biological hemolysis. Conclusion: There was no biological argument to support the hypothesis that SARS-CoV-2 could alter O2 binding to Hb.
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Affiliation(s)
- Thomas Gille
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Lucile Sesé
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Eric Aubourg
- CNRS, CEA, Astroparticule et Cosmologie, Université de Paris, Paris, France
| | - Emmanuelle E Fabre
- Laboratoire de Biochimie, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 978 ASIH, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Florence Cymbalista
- Inserm UMR 978 ASIH, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France.,Laboratoire d'Hématologie-Biologie, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Kayaththiry Caroline Ratnam
- Laboratoire d'Hématologie-Biologie, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Dominique Valeyre
- Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France.,Service de Pneumologie, Centre de Référence Maladies Pulmonaires Rares, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Hilario Nunes
- Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France.,Service de Pneumologie, Centre de Référence Maladies Pulmonaires Rares, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Jean-Paul Richalet
- Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
| | - Carole Planès
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Avicenne, GHUPSSD, Assistance Publique-Hôpitaux de Paris, Bobigny, France.,Inserm UMR 1272 "Hypoxie et Poumon," UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
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