Gupta Ruby, Singh Sukhmani, Anusim Nwabundo, Gupta Sachin, Gupta Sorab, Huben Marianne, Howard George, Jaiyesimi Ishmael
William Beaumont Hospital, Department of Hematology and Medical Oncology, Royal Oak, Michigan, USA.
Reading Hospital, Department of Internal Medicine, Reading, Pennsylvania, USA.
Eur J Case Rep Intern Med. 2021 Mar 10;8(3):002387. doi: 10.12890/2021_002387. eCollection 2021.
The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality worldwide. While patients with COVID-19 most frequently present with pneumonia, respiratory failure and acute respiratory distress syndrome, increasing cases of immune-mediated disorders such as autoimmune thrombocytopenia, haemolytic anaemia and antiphospholipid syndrome have been reported. In this article we describe a rare case of cold agglutinin syndrome (CAS) in a patient with COVID-19. The patient was a 77-year-old man with a history of glucose-6-phosphate dehydrogenase (G6PD) deficiency who presented with COVID-19 infection and acute respiratory failure. Initially he was started on intravenous steroids, antibiotics and hydroxychloroquine. Laboratory analysis revealed haemolytic anaemia with a positive direct anti-globulin test (DAT) and high titres of cold agglutinins. Hydroxychloroquine was stopped due to suspicion of haemolysis due to G6PD deficiency but the haemolysis persisted. Unfortunately, the respiratory failure progressed and the patient died. In summary, this article describes a rare case of CAS associated with COVID-19. CAS is a heterogenous group of cold autoimmune haemolytic anaemias occurring secondary to infections or malignancies. No definite treatment for CAS in COVID-19 patients has been approved so far.
Autoimmune haemolytic anaemia has been reported in COVID-19 patients.Cold agglutinin syndrome (CAS) can occur in patients with COVID-19.Efforts to determine the optimal management of CAS in COVID-19 patients must continue.
2019年冠状病毒病（COVID-19）大流行已在全球范围内造成了严重的发病和死亡情况。虽然COVID-19患者最常表现为肺炎、呼吸衰竭和急性呼吸窘迫综合征，但已有越来越多关于免疫介导疾病的病例报告，如自身免疫性血小板减少症、溶血性贫血和抗磷脂综合征。在本文中，我们描述了一名COVID-19患者罕见的冷凝集素综合征（CAS）病例。该患者为一名77岁男性，有葡萄糖-6-磷酸脱氢酶（G6PD）缺乏病史，表现为COVID-19感染和急性呼吸衰竭。最初，他开始接受静脉注射类固醇、抗生素和羟氯喹治疗。实验室分析显示为溶血性贫血，直接抗球蛋白试验（DAT）呈阳性，冷凝集素滴度高。由于怀疑是G6PD缺乏导致溶血，羟氯喹被停用，但溶血仍持续存在。不幸的是，呼吸衰竭进展，患者死亡。总之，本文描述了一例与COVID-19相关的罕见CAS病例。CAS是一组异质性的寒冷自身免疫性溶血性贫血，继发于感染或恶性肿瘤。目前尚未批准针对COVID-19患者CAS的确切治疗方法。
COVID-19患者中已报告有自身免疫性溶血性贫血。COVID-19患者可能发生冷凝集素综合征（CAS）。必须继续努力确定COVID-19患者CAS的最佳管理方法。
