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Hemolytic anemia in COVID-19
Hayder M Al-Kuraishy1, Ali I Al-Gareeb1, Ajeet Kaushik2
1Department of Clinical Pharmacology and Medicine, College of Medicine, ALmustansiriyia University, M.B.Ch.B, FRCP, Baghdad, Iraq.
Insights
Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) can cause hemolytic anemia through direct cell injury or autoimmune responses. Early detection and monitoring are crucial for managing this COVID-19 complication.
Area of Science:
- Hematology
- Virology
- Immunology
Background:
- COVID-19, caused by SARS-CoV-2, is a global pandemic.
- SARS-CoV-2 interacts with host cells via ACE2, CD147, and erythrocyte Band3 protein.
- Hemolytic anemia is a recognized complication of COVID-19.
Purpose of the Study:
- To comprehensively review the mechanisms linking SARS-CoV-2 infection to hemolytic anemia.
- To highlight the direct and indirect pathways of erythrocyte injury.
- To emphasize the importance of early diagnosis and management.
Main Methods:
- Literature review of studies on SARS-CoV-2, hemolytic anemia, and related mechanisms.
- Analysis of potential direct cytopathic effects of the virus on erythrocytes.
- Examination of indirect mechanisms, including autoantibody induction.
Main Results:
- SARS-CoV-2 can induce hemolytic anemia directly via cytopathic injury to erythrocytes.
- Indirectly, SARS-CoV-2 infection can trigger autoimmune hemolytic anemia through autoantibody formation.
- Hemolytic exacerbations may also occur due to COVID-19 treatments and vaccination.
Conclusions:
- SARS-CoV-2 infection presents a dual risk for hemolytic anemia, through direct injury and autoimmune pathways.
- Early detection and management of SARS-CoV-2-induced hemolytic anemia are vital for improving COVID-19 patient outcomes.
- Ongoing monitoring for hemolytic complications is necessary, considering potential drug and vaccine-related exacerbations. Intelligent nanosystems show promise for early diagnosis.
Abstract:
COVID-19 is a global pandemic triggered by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 entry point involves the interaction with angiotensin-converting enzyme 2 (ACE2) receptor, CD147, and erythrocyte Band3 protein. Hemolytic anemia has been linked to COVID-19 through induction of autoimmune hemolytic anemia (AIHA) caused by the formation of autoantibodies (auto-Abs) or directly through CD147 or erythrocyte Band3 protein-mediated erythrocyte injury. Here, we aim to provide a comprehensive view of the potential mechanisms contributing to hemolytic anemia during the SARS-CoV-2 infection. Taken together, data discussed here highlight that SARS-CoV-2 infection may lead to hemolytic anemia directly through cytopathic injury or indirectly through induction of auto-Abs. Thus, as SARS-CoV-2-induced hemolytic anemia is increasingly associated with COVID-19, early detection and management of this condition may prevent the poor prognostic outcomes in COVID-19 patients. Moreover, since hemolytic exacerbations may occur upon medicines for COVID-19 treatment and anti-SARS-CoV-2 vaccination, continued monitoring for complications is also required. Given that, intelligent nanosystems offer tools for broad-spectrum testing and early diagnosis of the infection, even at point-of-care sites.
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