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Hematologic autoimmune disorders in the course of COVID-19: a systematic review of reported cases
Erfan Taherifard1, Ehsan Taherifard1, Hamed Movahed1
1Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran.
Insights
COVID-19 can cause hematologic autoimmune disorders like immune thrombocytopenic purpura and autoimmune hemolytic anemia. Early consideration of autoimmune causes for abnormal blood counts in COVID-19 patients is crucial for timely treatment.
Area of Science:
- Hematology
- Immunology
- Infectious Diseases
Background:
- COVID-19 presents with diverse clinical manifestations, including hematological abnormalities.
- The specific autoimmune complications arising from COVID-19 infection are not fully understood.
Purpose of the Study:
- To systematically review and summarize the hematologic autoimmune complications observed in patients with COVID-19.
Main Methods:
- A comprehensive literature search was conducted across Medline, Scopus, and Web of Science.
- Eligible studies were identified, and data on patient history, presentations, paraclinical findings, treatment, and outcomes were extracted.
Main Results:
- Ninety-four COVID-19 patients with hematologic autoimmune disorders were identified across 58 documents.
- Immune thrombocytopenic purpura (55 cases) and autoimmune hemolytic anemia (22 cases) were the most frequent complications.
- Other reported disorders included antiphospholipid syndrome, thrombotic thrombocytopenic purpura, Evans syndrome, and autoimmune neutropenia.
Conclusions:
- An autoimmune etiology should be considered for unexplained hematologic findings in COVID-19 patients, particularly 1-2 weeks post-infection.
- Evaluating patients with decreased hemoglobin or platelet counts for COVID-19 may be warranted.
- Individualized treatment approaches are necessary due to the multifaceted nature of COVID-19 and its complications.
Objective:
As COVID-19 is a new emerging disease, the hematological/immunological changes that develop in the infected patients remain unknown. This study aims to systematically review the hematologic autoimmune complications in these patients.
Method:
Data from three online databases including Medline (via PubMed), Scopus and Web of Science were searched on 19 December 2020, and after excluding duplicate, irrelevant and inappropriate records, eligible documents were identified. Afterwards, information such as patients' history, presentations, paraclinical data, treatment course and outcome were extracted from the records.
Results:
A total of 58 documents were considered to be eligible for data extraction which described 94 patients with COVID-19 who developed hematologic autoimmune disorder in their course of infection. Of these patients with COVID-19, the most common hematologic autoimmune disorder was immune thrombocytopenic purpura (55 cases) followed by autoimmune hemolytic anemia (22 cases). Other hematologic autoimmune disorders include antiphospholipid syndrome, thrombotic thrombocytopenic purpura, Evans syndrome and autoimmune neutropenia.
Conclusion:
The current study would help us to always consider an autoimmune etiology for cases with abnormal hematologic finding which further lead to an appropriate treatment of the patients, especially when the symptoms present in about 1-2 weeks after the first manifestation of the infection symptoms. Maybe, at least in this pandemic, it should be recommended to evaluate patients with unexpected and unexplained decrease in their hemoglobulin or platelet count for COVID-19. Another challenging issue is the treatment options. Given the multiorgan involvement and multifaceted nature of the infection, an individualized approach should be taken for each patient.
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