Autoimmune Hemolytic Anemia as a Novel Complication of COVID-19 Infection in Sanglah General Hospital Bali, Indonesia

Abstract

BACKGROUND: Clinical manifestation of coronavirus disease (COVID-19) could be asymptomatic, mild to severe, even mortality. Although various hematological complications associated with COVID-19 infection have been reported, the finding of autoimmune hemolytic anemia (AIHA) is a novel case. 
 CASE REPORT: A 59-year-old woman was admitted to our emergency room because of a 5-day period of fever with cough and shortness of breath. At admission, she was takipnea, jaundice, and had an oxygen saturation of 60% on room air. Laboratory studies showed hemoglobin (Hb) 3.68 g/dL, high reticulocyte (14.4%), and hyperbilirubinemia. Chest X-ray showed bilateral pneumonia with positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test. Although she got packed red cell (PRC) transfusions in 7 days, her Hb remained low and bilateral infiltrate still increased. That’s why we considered direct Coombs test and it returned positive. AIHA was diagnosed and treatment with hydrocortisone 100 mg IV twice daily was given for the first 72 h. The maintenance dose with methylprednisolone 16 mg twice daily was continued for 7 days admission. Then, Hb value increased to 11.03 g/dL and she was discharged home without any compliments. 
 CONCLUSION: In the current epidemiological situation, AIHA needs to be considered as a complication of COVID-19 infection in a patient who presents with jaundice and severe anemia without any underlying chronic disease, which is need blood transfusions, steroid medication use, or blood cancer.