COVID-19-associated anemia: Difference between revisions
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==Overview== | ==Overview== | ||
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. | 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. | ||
==Historical Perspective== | ==Historical Perspective== | ||
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* On January 30, 2020, the [[outbreak]] was declared a Public Health Emergency of International Concern. | * On January 30, 2020, the [[outbreak]] was declared a Public Health Emergency of International Concern. | ||
* On March 12, 2020, the COVID-19 outbreak was declared a [[pandemic]] by the [[World Health Organization|World Health Organization (WHO)]]. | * On March 12, 2020, the [[COVID-19]] outbreak was declared a [[pandemic]] by the [[World Health Organization|World Health Organization (WHO)]]. | ||
==Classification== | ==Classification== | ||
The following is the classification of [[anemia]] by red blood cell size with [[Mean corpuscular volume|mean corpuscular volume (MCV)]]: | |||
* [[Macrocytic anemia]] (MCV>100) | |||
* [[Normocytic anemia]] (80<MCV<100) | |||
** High [[reticulocyte]] count | |||
** Low [[reticulocyte]] count | |||
< | |||
[ | |||
* [[Microcytic anemia]] (MCV<80) | |||
==Pathophysiology== | ==Pathophysiology== | ||
The pathophysiology | The pathophysiology of decrease in hemoglobin and rarity of anemia in patients with [[COVID-19]] infection are as the followings:<ref name="pmid32495027">{{cite journal| author=Liu X, Zhang R, He G| title=Hematological findings in coronavirus disease 2019: indications of progression of disease. | journal=Ann Hematol | year= 2020 | volume= | issue= | pages= | pmid=32495027 | doi=10.1007/s00277-020-04103-5 | pmc=7266734 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32495027 }} </ref> | ||
*[[Erythropoiesis]] may be affected by inflammation during COVID-19 infection which leads to decrease in hemoglobin.<ref name="pmid32495027" /> | *[[Erythropoiesis]] may be affected by [[inflammation]] during [[COVID-19]] infection which leads to decrease in [[hemoglobin]].<ref name="pmid32495027" /> | ||
*[[Anemia]] is not a common finding probably due to the compensation of [[Red blood cell|erythrocyte]] proliferation caused by [[pneumonia]]-induced [[Hypoxemia|hypoxia]] and the long life span of [[erythrocytes]].<ref name="pmid32495027" /> | *[[Anemia]] is not a common finding probably due to the compensation of [[Red blood cell|erythrocyte]] proliferation caused by [[pneumonia]]-induced [[Hypoxemia|hypoxia]] and the long life span of [[erythrocytes]].<ref name="pmid32495027" /> | ||
==Causes== | ==Causes== | ||
[[Inflammation]] caused by COVID-19 infection affects [[erythropoiesis]] and decreases [[hemoglobin]].<ref name="pmid32495027" /> | |||
==Differentiating COVID-19-associated Anemia from other Diseases== | |||
==Differentiating | |||
<s>[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].</s> | <s>[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].</s> | ||
Line 104: | Line 73: | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
* 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.<ref name="pmid32495027" /><ref name="pmid32109013" /> | * Although [[anemia]] is not a common finding in patients with COVID-19 infection, but decrease in [[hemoglobin]] in patients with severe COVID-19 infection has been reported.<ref name="pmid32495027" /><ref name="pmid32109013" /> | ||
* The median hemoglobin is lower in patients with severe COVID-19 (12.8 g/dL) compared to patients with non-severe infection (13.5 g/dL).<ref name="pmid32109013" /> | * The median hemoglobin is lower in patients with severe COVID-19 (12.8 g/dL) compared to patients with non-severe infection (13.5 g/dL).<ref name="pmid32109013" /> | ||
* Decrease in hemoglobin is seen more in critically ill patients with severe COVID-19 infection.<ref name="pmid32109013" /> | * Decrease in hemoglobin is seen more in critically ill patients with severe COVID-19 infection.<ref name="pmid32109013" /> | ||
==Diagnosis== | ==Diagnosis== | ||
=== | ===Diagnostic Study of Choice=== | ||
* The [[diagnostic study of choice]] for [[thrombocytopenia]] is compelete blood count (CBC). | |||
* Anemia is defined by | |||
* The median hemoglobin is lower in patients with severe COVID-19 (12.8 g/dL) compared to patients with non-severe infection (13.5 g/dL).<ref name="pmid32109013" /> | |||
< | |||
===<s>History and Symptoms</s>=== | ===<s>History and Symptoms</s>=== | ||
Line 151: | Line 107: | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
The median hemoglobin is lower in patients with severe COVID-19 (12.8 g/dL) compared to patients with non-severe infection (13.5 g/dL).<ref name="pmid32109013" /> | |||
* Compelete blood count (CBC)''':''' | |||
** The median hemoglobin is lower in patients with severe COVID-19 (12.8 g/dL) compared to patients with non-severe infection (13.5 g/dL).<ref name="pmid32109013" /> | |||
* [[Blood film|Peripheral blood smear]]: | |||
===<s>Electrocardiogram</s>=== | ===<s>Electrocardiogram</s>=== |
Revision as of 09:57, 27 June 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Synonyms and keywords:
Overview
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.
Historical Perspective
- 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.[1][2]
- On January 30, 2020, the outbreak was declared a Public Health Emergency of International Concern.
- On March 12, 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO).
Classification
The following is the classification of anemia by red blood cell size with mean corpuscular volume (MCV):
- Macrocytic anemia (MCV>100)
- Normocytic anemia (80<MCV<100)
- High reticulocyte count
- Low reticulocyte count
- Microcytic anemia (MCV<80)
Pathophysiology
The pathophysiology of decrease in hemoglobin and rarity of anemia in patients with COVID-19 infection are as the followings:[3]
- Erythropoiesis may be affected by inflammation during COVID-19 infection which leads to decrease in hemoglobin.[3]
- Anemia is not a common finding probably due to the compensation of erythrocyte proliferation caused by pneumonia-induced hypoxia and the long life span of erythrocytes.[3]
Causes
Inflammation caused by COVID-19 infection affects erythropoiesis and decreases hemoglobin.[3]
Differentiating COVID-19-associated Anemia from other Diseases
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
Epidemiology and Demographics
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.[3][4]
Risk Factors
There are no established risk factors for [disease name].
OR
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
OR
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
OR
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
Screening
There is insufficient evidence to recommend routine screening for [disease/malignancy].
OR
According to the [guideline name], screening for [disease name] is not recommended.
OR
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
Natural History, Complications, and Prognosis
- Although anemia is not a common finding in patients with COVID-19 infection, but decrease in hemoglobin in patients with severe COVID-19 infection has been reported.[3][4]
- The median hemoglobin is lower in patients with severe COVID-19 (12.8 g/dL) compared to patients with non-severe infection (13.5 g/dL).[4]
- Decrease in hemoglobin is seen more in critically ill patients with severe COVID-19 infection.[4]
Diagnosis
Diagnostic Study of Choice
- The diagnostic study of choice for thrombocytopenia is compelete blood count (CBC).
- Anemia is defined by
- The median hemoglobin is lower in patients with severe COVID-19 (12.8 g/dL) compared to patients with non-severe infection (13.5 g/dL).[4]
History and Symptoms
The majority of patients with [disease name] are asymptomatic.
OR
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
Physical Examination
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
Laboratory Findings
- Compelete blood count (CBC):
- The median hemoglobin is lower in patients with severe COVID-19 (12.8 g/dL) compared to patients with non-severe infection (13.5 g/dL).[4]
Electrocardiogram
There are no ECG findings associated with [disease name].
OR
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
X-ray
There are no x-ray findings associated with [disease name].
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with [disease name].
OR
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
CT scan
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
MRI
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Other Imaging Findings
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Surgery
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
Primary Prevention
There are no established measures for the primary prevention of [disease name].
OR
There are no available vaccines against [disease name].
OR
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
OR
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
Secondary Prevention
There are no established measures for the secondary prevention of [disease name].
OR
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
References
- ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty
|title=
(help) - ↑ 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.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 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). - ↑ 4.0 4.1 4.2 4.3 4.4 4.5 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).