COVID-19-associated anemia: Difference between revisions
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==Differentiating COVID-19-associated Anemia from other Diseases== | ==Differentiating COVID-19-associated Anemia from other Diseases== | ||
* Covid-19 causes acute onset [[aplastic anemia]].<ref name="ZhouYu2020">{{cite journal|last1=Zhou|first1=Fei|last2=Yu|first2=Ting|last3=Du|first3=Ronghui|last4=Fan|first4=Guohui|last5=Liu|first5=Ying|last6=Liu|first6=Zhibo|last7=Xiang|first7=Jie|last8=Wang|first8=Yeming|last9=Song|first9=Bin|last10=Gu|first10=Xiaoying|last11=Guan|first11=Lulu|last12=Wei|first12=Yuan|last13=Li|first13=Hui|last14=Wu|first14=Xudong|last15=Xu|first15=Jiuyang|last16=Tu|first16=Shengjin|last17=Zhang|first17=Yi|last18=Chen|first18=Hua|last19=Cao|first19=Bin|title=Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study|journal=The Lancet|volume=395|issue=10229|year=2020|pages=1054–1062|issn=01406736|doi=10.1016/S0140-6736(20)30566-3}}</ref> | *<s>Covid-19 causes acute onset [[aplastic anemia]].<ref name="ZhouYu2020">{{cite journal|last1=Zhou|first1=Fei|last2=Yu|first2=Ting|last3=Du|first3=Ronghui|last4=Fan|first4=Guohui|last5=Liu|first5=Ying|last6=Liu|first6=Zhibo|last7=Xiang|first7=Jie|last8=Wang|first8=Yeming|last9=Song|first9=Bin|last10=Gu|first10=Xiaoying|last11=Guan|first11=Lulu|last12=Wei|first12=Yuan|last13=Li|first13=Hui|last14=Wu|first14=Xudong|last15=Xu|first15=Jiuyang|last16=Tu|first16=Shengjin|last17=Zhang|first17=Yi|last18=Chen|first18=Hua|last19=Cao|first19=Bin|title=Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study|journal=The Lancet|volume=395|issue=10229|year=2020|pages=1054–1062|issn=01406736|doi=10.1016/S0140-6736(20)30566-3}}</ref></s> | ||
*For other causes of aplastic anemia, click [[Aplastic anemia differential diagnosis|here]]. | *<s>For other causes of aplastic anemia, click [[Aplastic anemia differential diagnosis|here]].</s> | ||
*Differential diagnosis of [[anemia]] may include:<ref name="pmid28189170">{{cite journal| author=Cascio MJ, DeLoughery TG| title=Anemia: Evaluation and Diagnostic Tests. | journal=Med Clin North Am | year= 2017 | volume= 101 | issue= 2 | pages= 263-284 | pmid=28189170 | doi=10.1016/j.mcna.2016.09.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28189170 }} </ref> | *Differential diagnosis of [[anemia]] may include:<ref name="pmid28189170">{{cite journal| author=Cascio MJ, DeLoughery TG| title=Anemia: Evaluation and Diagnostic Tests. | journal=Med Clin North Am | year= 2017 | volume= 101 | issue= 2 | pages= 263-284 | pmid=28189170 | doi=10.1016/j.mcna.2016.09.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28189170 }} </ref> | ||
**[[Iron deficiency anemia]] | **[[Iron deficiency anemia]] | ||
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==Screening== | ==Screening== | ||
There is insufficient evidence to recommend routine screening for [[anemia]] in [[COVID-19]] infection. | |||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
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* The [[diagnostic study of choice]] for [[anemia]] is compelete blood count (CBC). | * The [[diagnostic study of choice]] for [[anemia]] is compelete blood count (CBC). | ||
* Anemia is defined by | * Anemia is defined as a hemoglobin level of less than 13 g/dL in men and less than 12 g/dL in women by the World Health Organization (WHO). | ||
* 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" /> | ||
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===Electrocardiogram=== | ===Electrocardiogram=== | ||
There are no [[The electrocardiogram|ECG]] findings associated with [[COVID-19]]-associated-[[anemia]]. | |||
===X-ray=== | ===X-ray=== | ||
There are no [[X-rays|x-ray]] findings associated with [[ | There are no [[X-rays|x-ray]] findings associated with [[COVID-19]]-associated-[[anemia]]. | ||
===Echocardiography or Ultrasound=== | ===Echocardiography or Ultrasound=== | ||
There are no echocardiography/ultrasound | There are no echocardiography/ultrasound findings associated with [[COVID-19]]-associated-[[anemia]]. | ||
===CT scan=== | ===CT scan=== | ||
There are no [[Computed tomography|CT]] scan findings associated with [[ | There are no [[Computed tomography|CT]] scan findings associated with [[COVID-19]]-associated-[[anemia]]. | ||
===MRI=== | ===MRI=== | ||
There are no [[Magnetic resonance imaging|MRI]] findings associated with [[ | There are no [[Magnetic resonance imaging|MRI]] findings associated with [[COVID-19]]-associated-[[anemia]]. | ||
===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
There are no other imaging findings associated with [[ | There are no other imaging findings associated with [[COVID-19]]-associated-[[anemia]]. | ||
===Other Diagnostic Studies<ref name="pmid28189170" />=== | ===Other Diagnostic Studies<ref name="pmid28189170" />=== | ||
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==Treatment== | ==Treatment== | ||
=== | ===Medical Therapy=== | ||
Treatment of [[anemia]] depends on the cause of anemia.<ref name="pmid27866575" /> No specific treatment has been reported for [[COVID-19]]-associated-[[anemia]]. | |||
===Surgery=== | ===Surgery=== | ||
Surgery is not a treatment option for patients with [[ | Surgery is not a treatment option for patients with[[COVID-19]]-associated-[[anemia]]. | ||
===Primary Prevention=== | ===Primary Prevention=== | ||
There are no established measures for the primary prevention of [[ | There are no established measures for the primary prevention of [[COVID-19]]-associated-[[anemia]]. | ||
===Secondary Prevention=== | ===Secondary Prevention=== | ||
Minimal amount of blood blood should be drawn for blood tests and only clinically necessary tests should be ordered in order to prevent aggregation of [[ | Minimal amount of blood blood should be drawn for blood tests and only clinically necessary tests should be ordered in order to prevent aggregation of [[COVID-19]]-associated-[[anemia]].<ref name="pmid32339260">{{cite journal| author=Baron DM, Franchini M, Goobie SM, Javidroozi M, Klein AA, Lasocki S | display-authors=etal| title=Patient blood management during the COVID-19 pandemic: a narrative review. | journal=Anaesthesia | year= 2020 | volume= | issue= | pages= | pmid=32339260 | doi=10.1111/anae.15095 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32339260 }} </ref> | ||
==References== | ==References== | ||
Revision as of 13:22, 27 June 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
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
- Anemia is defined as a hemoglobin level of less than 13 g/dL in men and less than 12 g/dL in women by the World Health Organization (WHO).
- 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
Covid-19 causes acute onset aplastic anemia.[4]For other causes of aplastic anemia, click here.- Differential diagnosis of anemia may include:[5]
- Iron deficiency anemia
- Thalassemia
- Sideroblastic anemia
- Anemia of inflammation
- Aplastic anemia
- Hypothyroidism
- Liver disease
- Renal disease
- Reticulocytosis
- Thyroid disease
- Vitamin B12 and folate deficiency
- Chemotherapy
- Myelodysplastic syndrome
- Acute onset hemolysis or blood loss
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][6]
Risk Factors
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][6]
Screening
There is insufficient evidence to recommend routine screening for anemia in COVID-19 infection.
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][6]
- 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).[6]
- Decrease in hemoglobin is seen more in critically ill patients with severe COVID-19 infection.[6]
Diagnosis
Diagnostic Study of Choice
- The diagnostic study of choice for anemia is compelete blood count (CBC).
- Anemia is defined as a hemoglobin level of less than 13 g/dL in men and less than 12 g/dL in women by the World Health Organization (WHO).
- 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).[6]
History and Symptoms
- 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][6]
- 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).[6]
- Anemia is defined as a hemoglobin level of less than 13 g/dL in men and less than 12 g/dL in women by the World Health Organization (WHO).
- Patients with anemia should be asked about:[7]
- Blood loss
- Duration of the anemia
- Any associated features
- Infection
- Cancer
- Comorbidities that cause anemia (such as renal failure, rheumatoid arthritis, and inflammatory bowel disease)
- Past medical history
- Patient’s ethnicity may influence the differential
- Family history
- Drug history (aspirin and NSAIDs)
Physical Examination
- 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][6]
- 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).[6]
- Anemia is defined as a hemoglobin level of less than 13 g/dL in men and less than 12 g/dL in women by the World Health Organization (WHO).
- The physical examination in patients with anemia may include checking for:[7]
- Pallor of the conjunctiva
- Lymphadenopathy
- Hepatosplenomegaly
- Bone tenderness
- Petechiae
- Ecchymose
Laboratory Findings[5]
- Compelete blood count (CBC):
- Peripheral blood smear: May be helpful if there is a suspicion of other causes of anemia.
- Reticulocyte count : May be helpful if there is a suspicion of other causes of anemia.
- Red cell indices: May be helpful if there is a suspicion of other causes of anemia.
Electrocardiogram
There are no ECG findings associated with COVID-19-associated-anemia.
X-ray
There are no x-ray findings associated with COVID-19-associated-anemia.
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with COVID-19-associated-anemia.
CT scan
There are no CT scan findings associated with COVID-19-associated-anemia.
MRI
There are no MRI findings associated with COVID-19-associated-anemia.
Other Imaging Findings
There are no other imaging findings associated with COVID-19-associated-anemia.
Other Diagnostic Studies[5]
- Bone marrow examination: May be helpful if there is a suspicion of other causes of anemia.
- Cytogenetic and molecular tests : May be helpful if there is a suspicion of other causes of anemia.
Treatment
Medical Therapy
Treatment of anemia depends on the cause of anemia.[7] No specific treatment has been reported for COVID-19-associated-anemia.
Surgery
Surgery is not a treatment option for patients withCOVID-19-associated-anemia.
Primary Prevention
There are no established measures for the primary prevention of COVID-19-associated-anemia.
Secondary Prevention
Minimal amount of blood blood should be drawn for blood tests and only clinically necessary tests should be ordered in order to prevent aggregation of COVID-19-associated-anemia.[8]
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 3.6 3.7 3.8 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). - ↑ Zhou, Fei; Yu, Ting; Du, Ronghui; Fan, Guohui; Liu, Ying; Liu, Zhibo; Xiang, Jie; Wang, Yeming; Song, Bin; Gu, Xiaoying; Guan, Lulu; Wei, Yuan; Li, Hui; Wu, Xudong; Xu, Jiuyang; Tu, Shengjin; Zhang, Yi; Chen, Hua; Cao, Bin (2020). "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study". The Lancet. 395 (10229): 1054–1062. doi:10.1016/S0140-6736(20)30566-3. ISSN 0140-6736.
- ↑ 5.0 5.1 5.2 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.
- ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 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). - ↑ 7.0 7.1 7.2 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.
- ↑ 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).