Autoimmune Hemolytic Anemia As Initial Presentation of COVID-19 Infection

Introduction: the spectrum of autoimmune complications in patients with SARS-COV2 infection (also known as COVID-19) is broader and includes autoimmune thrombocytopenia and antiphospholipid syndrome among others. (Autoimmunity Reviews 19 (2020) 102597) The reports of autoimmune hemolytic anemia (AIHA) are increasing too, but mainly is an immune dysregulation setting. Cases: here we report two cases of AIHA in a non immune dysregulation setting. Two females, 35 and 58 years old, presented to emergency service due severe anemic syndrome, severe pallor, dyspnea and mild fever. Work up was started and warm IgG - C3d autoantibodies AIHA was diagnosed. Extension studies included chest X-rays that showed basal infiltrates in both patients; lung CT scan were performed and revealed interstitial pneumonia predominantly in both lung bases. The PCR fo SARS-COV2 was positive for both patients. Treatment with methylprednisolone 1 gr per day for three days and IgG IV 1 gr/kg days 1 and 3. Treatment for COVID-19 was started according to institutional protocols. The evolution in both patients were to partial remission and needs prednisone 20 mg/day and still in it at the time of these report. Images show lung infiltrates and increased 56% reticulocytes count from one of the patients. Conclusion: the exact etiology of autoimmune diseases still unknown, but there are various factors, including viral infections, that contributes to the trigger of these type of diseases. AIHA has been associated with COVID-19 and it is postulated that molecular mimicry between Ankyrin-1 in the erythrocyte surface and the viral protein spike as the precipitating event. (Br J Haematol 2020;190:e92-e93) There are scanty cases of AIHA in the setting of COVID-19, the majority in the previously immune dysregulated patients (lymphoid neoplasias and autoimmune diseases); only two previously cases of AIHA with no underlaying disorder. We suggest that the work up for every patient with AIHA would include a lung CT Scan and PCR for SARS-COV2. There are not guidelines for treatment, but the lowest dose and time of steroids with IgG IV could be an option as recommended in guidelines for primary immune thrombocytopenia in the setting of COVID-19 infection. (Br J Haematol 2020;189:1038-1043). [Figure: see text] DISCLOSURES: No relevant conflicts of interest to declare.