Adnan Menderes University Hematology Department, Aytepe Mevki, Efeler, PC: 09010, Aydın, Turkey.
Transfus Apher Sci. 2022 Jun;61(3):103339. doi: 10.1016/j.transci.2021.103339. Epub 2021 Dec 7.
Evans syndrome is a rare condition characterized by simultaneous or sequential development of autoimmune hemolytic anemia and immune thrombocytopenia (and/or immune neutropenia). Coronavirus disease 2019 (COVID-19) may cause various hematologic conditions, such as coagulation abnormalities (e.g., bleeding or thrombosis) or cell count alterations (e.g., lymphopenia and neutrophilia). COVID-19 may also induce Evans syndrome via immune mechanisms. Here, we describe the case of a patient developing Evans syndrome shortly after COVID-19 infection. Immune thrombocytopenia and warm-type autoimmune hemolytic anemia developed simultaneously, and intravenous immunoglobulin and methylprednisolone were initially administered. Additionally, we intend to review all COVID-19-induced Evans syndrome cases currently present in the literature and emphasize the differences as well as the similarities regarding patient characteristics, relationship to COVID-19 infection, and treatment approach. Since autoimmune cytopenias are frequent in COVID-19 patients, clinicians should pay particular attention to profound and abrupt-onset cytopenias. In these circumstances, hemolysis markers such as lactate dehydrogenase, haptoglobulin, Coombs tests, etc. should be investigated, and the possibility of Evans syndrome should always be considered to ensure prompt and appropriate treatment. These factors are essential to ensure hematologic recovery and prevent complications such as thrombosis.
Evans 综合征是一种罕见病症，其特征为自身免疫性溶血性贫血和免疫性血小板减少症（和/或免疫性中性粒细胞减少症）同时或相继发生。2019 年冠状病毒病（COVID-19）可引起各种血液病症，例如凝血异常（例如，出血或血栓形成）或细胞计数改变（例如，淋巴细胞减少和中性粒细胞增多）。COVID-19 也可能通过免疫机制引起 Evans 综合征。在此，我们描述了一例 COVID-19 感染后不久发生 Evans 综合征的患者。免疫性血小板减少症和温型自身免疫性溶血性贫血同时发生，最初给予了静脉注射免疫球蛋白和甲基强的松龙治疗。此外，我们旨在回顾目前文献中所有与 COVID-19 相关的 Evans 综合征病例，并强调患者特征、与 COVID-19 感染的关系以及治疗方法方面的差异和相似之处。由于 COVID-19 患者中常发生自身免疫性血细胞减少症，临床医生应特别注意严重且突然发生的血细胞减少症。在这些情况下，应检查乳酸脱氢酶、触珠蛋白、抗人球蛋白试验等溶血标志物，并应始终考虑 Evans 综合征的可能性，以确保及时和适当的治疗。这些因素对于确保血液学恢复和预防血栓形成等并发症至关重要。
