COVID-19-associated anemia: Difference between revisions
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==Overview== | ==Overview== | ||
[[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 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). 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]]. | [[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 g/dL in men and less than 12 g/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== | ==Historical Perspective== | ||
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==Classification== | ==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). | * Anemia in general 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|mean corpuscular volume (MCV)]]: | * The following is the classification of [[anemia]] in general by red blood cell size with [[Mean corpuscular volume|mean corpuscular volume (MCV)]]: | ||
** [[Macrocytic anemia]] (MCV>100) | **[[Macrocytic anemia]] (MCV>100) | ||
**[[Normocytic anemia]] (80<MCV<100) | **[[Normocytic anemia]] (80<MCV<100) | ||
*** High [[reticulocyte]] count | *** High [[reticulocyte]] count | ||
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==Causes== | ==Causes== | ||
[[ | [[COVID-19|Coronavirus disease 2019 (COVID-19)]] caused by a novel [[coronavirus]] called [[SARS-CoV-2]] is the cause of [[COVID-19]]-associated-[[anemia]]. | ||
==Differentiating COVID-19-associated Anemia from other Diseases== | ==Differentiating COVID-19-associated Anemia from other Diseases== | ||
Differential diagnosis of [[anemia]] in general 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]] | |||
*[[Thalassemia]] | |||
*[[Sideroblastic anemia]] | |||
*Anemia of inflammation | |||
*[[Aplastic anemia]] | |||
*[[Hypothyroidism]] | |||
*[[Liver]] disease | |||
*[[Kidney|Renal]] disease | |||
*Reticulocytosis | |||
*[[Thyroid]] disease | |||
*Vitamin [[Vitamin B12 deficiency|B12]] and [[folate deficiency]] | |||
*[[Chemotherapy]] | |||
*[[Myelodysplastic syndrome]] | |||
*Acute onset [[hemolysis]] or blood loss | |||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
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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 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). | * Anemia in general 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" /> | ||
| Line 84: | Line 84: | ||
* 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" /> | * 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" /> | ||
*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). | *Anemia in general 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:<ref name="pmid27866575">{{cite journal| author=Powell DJ, Achebe MO| title=Anemia for the Primary Care Physician. | journal=Prim Care | year= 2016 | volume= 43 | issue= 4 | pages= 527-542 | pmid=27866575 | doi=10.1016/j.pop.2016.07.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27866575 }} </ref> | *There is insufficient information about the symptoms of [[COVID-19]]-associated-[[anemia]]. | ||
* Patients with anemia in general should be asked about:<ref name="pmid27866575">{{cite journal| author=Powell DJ, Achebe MO| title=Anemia for the Primary Care Physician. | journal=Prim Care | year= 2016 | volume= 43 | issue= 4 | pages= 527-542 | pmid=27866575 | doi=10.1016/j.pop.2016.07.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27866575 }} </ref> | |||
** Blood loss | ** Blood loss | ||
** Duration of the anemia | ** Duration of the anemia | ||
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* 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" /> | * 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" /> | ||
*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). | *Anemia in general 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:<ref name="pmid27866575" /> | *There is insufficient information about the signs found on physical examniation of [[COVID-19]]-associated-[[anemia]]. | ||
* The [[physical examination]] in patients with [[anemia]] in general may include checking for:<ref name="pmid27866575" /> | |||
** Pallor of the [[conjunctiva]] | ** Pallor of the [[conjunctiva]] | ||
**[[Lymphadenopathy]] | **[[Lymphadenopathy]] | ||
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** 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" /> | ||
*[[Blood film|Peripheral blood smear]]: May be helpful if there is a suspicion of other causes of [[anemia]]. | *[[Blood film|Peripheral blood smear]]: May be helpful if there is a suspicion of other causes of [[anemia]]. However, routine [[Blood film|peripheral blood smear]] has not been recommended in COVID 19 patients. | ||
*[[Reticulocyte]] count : 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]]. | *Red cell indices: May be helpful if there is a suspicion of other causes of [[anemia]]. | ||
**[[Mean corpuscular volume|MCV]] | **[[Mean corpuscular volume|MCV]] | ||
| Line 142: | Line 144: | ||
===Other Diagnostic Studies<ref name="pmid28189170" />=== | ===Other Diagnostic Studies<ref name="pmid28189170" />=== | ||
* [[Bone marrow examination]]: May be helpful if there is a suspicion of other causes of [[anemia]]. | * [[Bone marrow examination]]: May be helpful if there is a suspicion of other causes of [[anemia]]. However, routine bone marrow examination has not been recommended in COVID-19 patients | ||
* [[Cytogenetics|Cytogenetic]] and [[Molecule|molecular]] tests : May be helpful if there is a suspicion of other causes of [[anemia]]. | * [[Cytogenetics|Cytogenetic]] and [[Molecule|molecular]] tests : May be helpful if there is a suspicion of other causes of [[anemia]]. However, routine cytogenetic and molecular tests have not been recommended in COVID 19 patients. | ||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===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]]. | Treatment of [[anemia]] in general depends on the cause of anemia.<ref name="pmid27866575" /> No specific treatment has been reported for [[COVID-19]]-associated-[[anemia]]. | ||
===Surgery=== | ===Surgery=== | ||
Revision as of 16:20, 1 July 2020
For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here
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
Overview
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 g/dL in men and less than 12 g/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
- 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 in general 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 in general 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
Coronavirus disease 2019 (COVID-19) caused by a novel coronavirus called SARS-CoV-2 is the cause of COVID-19-associated-anemia.
Differentiating COVID-19-associated Anemia from other Diseases
Differential diagnosis of anemia in general may include:[4]
- 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
- Anemia is a very rare complication of COVID-19.[3]
- There is no new update about COVID-19 associated anemia.
Risk Factors
There is no associated risk factor For COVID-19 associated anemia.
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][5]
- 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).[5]
- Decrease in hemoglobin is seen more in critically ill patients with severe COVID-19 infection.[5]
Diagnosis
Diagnostic Study of Choice
- The diagnostic study of choice for anemia is compelete blood count (CBC).
- Anemia in general 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).[5]
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][5]
- 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).[5]
- Anemia in general 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).
- There is insufficient information about the symptoms of COVID-19-associated-anemia.
- Patients with anemia in general should be asked about:[6]
- 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][5]
- 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).[5]
- Anemia in general 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).
- There is insufficient information about the signs found on physical examniation of COVID-19-associated-anemia.
- The physical examination in patients with anemia in general may include checking for:[6]
- Pallor of the conjunctiva
- Lymphadenopathy
- Hepatosplenomegaly
- Bone tenderness
- Petechiae
- Ecchymose
Laboratory Findings[4]
- Compelete blood count (CBC):
- Peripheral blood smear: May be helpful if there is a suspicion of other causes of anemia. However, routine peripheral blood smear has not been recommended in COVID 19 patients.
- 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[4]
- Bone marrow examination: May be helpful if there is a suspicion of other causes of anemia. However, routine bone marrow examination has not been recommended in COVID-19 patients
- Cytogenetic and molecular tests : May be helpful if there is a suspicion of other causes of anemia. However, routine cytogenetic and molecular tests have not been recommended in COVID 19 patients.
Treatment
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
Surgery is not a treatment option for patients with COVID-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.[7]
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 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 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.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 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). - ↑ 6.0 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.
- ↑ 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).