COVID-19-associated anemia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Synonyms and keywords: Hemoglobin changes in COVID 19, anemia in COVID 19, effects on erythropoiesis in COVID 19


Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus called SARS-CoV-2, which caused a respiratory illness outbreak that was first detected in Wuhan, China. Anemia in general is defined as a hemoglobin level of less than 13 gm/dL in men and less than 12 gm/dL in women by the World Health Organization (WHO). Although anemia is not a common finding in patients with COVID-19 infection, decrease in hemoglobin in patients with severe COVID-19 infection has been reported. The pathophysiology of decrease in hemoglobin in patients with COVID-19 infection are hypothetically affected erythropoiesis due to inflammation during COVID-19 infection which leads to decrease in hemoglobin.

Historical Perspective


Here is a schematic representation of how to consider anemia with MCV as the starting point:

Other characteristics visible on the peripheral smear may provide valuable clues about a more specific diagnosis; for example, abnormal white blood cells may point to a cause in the bone marrow.


The pathophysiology of decrease in hemoglobin and rarity of anemia in patients with COVID-19 infection are as the followings:[3]


Differentiating COVID-19-associated Anemia from other Diseases

For complete differential diagnosis of anemia please click here.

Epidemiology and Demographics

Risk Factors


Natural History, Complications, and Prognosis


Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings



  • There are no x-ray findings associated with COVID-19 associated anemia.
  • To view X-ray findings of COVID-19 ,click here.

Echocardiography or Ultrasound

CT scan

  • There are no CT scan findings associated with COVID-19 associated-anemia.
  • To view the CT scan findings on COVID-19, click here.


Other Imaging Findings

  • There are no other imaging findings associated with COVID-19 associated-anemia.
  • To view other imaging findings on COVID-19, click here.

Other Diagnostic Studies


Medical Therapy

  • Treatment of anemia in general depends on the cause of anemia.[6]
  • No specific treatment has been reported for COVID-19-associated-anemia.


  • Surgery is not a treatment option for patients with COVID-19 associated anemia.

Primary Prevention

Secondary Prevention


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  2. Lu, Jian; Cui, Jie; Qian, Zhaohui; Wang, Yirong; Zhang, Hong; Duan, Yuange; Wu, Xinkai; Yao, Xinmin; Song, Yuhe; Li, Xiang; Wu, Changcheng; Tang, Xiaolu (2020). "On the origin and continuing evolution of SARS-CoV-2". National Science Review. doi:10.1093/nsr/nwaa036. ISSN 2095-5138.
  3. 3.0 3.1 3.2 3.3 3.4 Liu X, Zhang R, He G (2020). "Hematological findings in coronavirus disease 2019: indications of progression of disease". Ann Hematol. doi:10.1007/s00277-020-04103-5. PMC 7266734 Check |pmc= value (help). PMID 32495027 Check |pmid= value (help).
  4. 4.0 4.1 4.2 Cascio MJ, DeLoughery TG (2017). "Anemia: Evaluation and Diagnostic Tests". Med Clin North Am. 101 (2): 263–284. doi:10.1016/j.mcna.2016.09.003. PMID 28189170.
  5. 5.0 5.1 5.2 5.3 5.4 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N Engl J Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check |pmc= value (help). PMID 32109013 Check |pmid= value (help).
  6. 6.0 6.1 6.2 Powell DJ, Achebe MO (2016). "Anemia for the Primary Care Physician". Prim Care. 43 (4): 527–542. doi:10.1016/j.pop.2016.07.006. PMID 27866575.
  7. Gv S, Pk S, Herur A, Chinagudi S, Patil SS, Ankad RB; et al. (2014). "Correlation Between Haemoglobin Level and Electrocardiographic (ECG) Findings in Anaemia: A Cross-Sectional Study". J Clin Diagn Res. 8 (4): BC04–6. doi:10.7860/JCDR/2014/8966.4202. PMC 4064835. PMID 24959433.
  8. Baron DM, Franchini M, Goobie SM, Javidroozi M, Klein AA, Lasocki S; et al. (2020). "Patient blood management during the COVID-19 pandemic: a narrative review". Anaesthesia. doi:10.1111/anae.15095. PMID 32339260 Check |pmid= value (help).

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