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 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]].
[[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|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 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).
* 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|World Health Organization (WHO)]].


* The following is the classification of [[anemia]] in general 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)]]:
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==Pathophysiology==
==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>
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" />
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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">{{cite journal| author=Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX | display-authors=etal| title=Clinical Characteristics of Coronavirus Disease 2019 in China. | journal=N Engl J Med | year= 2020 | volume= 382 | issue= 18 | pages= 1708-1720 | pmid=32109013 | doi=10.1056/NEJMoa2002032 | pmc=7092819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32109013  }} </ref>
* 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">{{cite journal| author=Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX | display-authors=etal| title=Clinical Characteristics of Coronavirus Disease 2019 in China. | journal=N Engl J Med | year= 2020 | volume= 382 | issue= 18 | pages= 1708-1720 | pmid=32109013 | doi=10.1056/NEJMoa2002032 | pmc=7092819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32109013  }} </ref>
* 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==
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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 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).
* 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|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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* 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 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).
*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|World Health Organization (WHO)]].
*There is insufficient information about the symptoms of  [[COVID-19]]-associated-[[anemia]].
*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>
* 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  
** Any associated features  
** Any associated features  
** Infection
**[[Infection]]
**[[Cancer]]
**[[Cancer]]
** Comorbidities that cause anemia (such as [[Renal insufficiency|renal failure]], [[rheumatoid arthritis]], and [[inflammatory bowel disease]])
** Comorbidities that cause [[anemia]] (such as [[Renal insufficiency|renal failure]], [[rheumatoid arthritis]], and [[inflammatory bowel disease]])
** Past medical history
** Past medical history
** Patient’s ethnicity may influence the differential  
** Patient’s ethnicity may influence the differential  
** Family history
**[[Family history]]
** Drug history ([[aspirin]] and [[Non-steroidal anti-inflammatory drug|NSAIDs]])
** Drug history ([[aspirin]] and [[Non-steroidal anti-inflammatory drug|NSAIDs]])


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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 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).
*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|World Health Organization (WHO)]].
*There is insufficient information about the signs found on physical examniation of  [[COVID-19]]-associated-[[anemia]].
*There is insufficient information about the signs found on [[physical examination]] of  [[COVID-19]]-associated-[[anemia]].
* The [[physical examination]] in patients with [[anemia]] in general may include checking for:<ref name="pmid27866575" />
* The [[physical examination]] in patients with [[anemia]] in general may include checking for:<ref name="pmid27866575" />
** Pallor of the [[conjunctiva]] 
** Pallor of the [[conjunctiva]] 
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* Compelete blood count (CBC)''':<ref name="pmid28189170" /><ref name="pmid32109013" />'''
* Compelete blood count (CBC)''':<ref name="pmid28189170" /><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).
** 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).


*[[Blood film|Peripheral blood smear]]: May be helpful if there is a suspicion of other causes of [[anemia]].  However, there is insufficient evidence recommending routine [[Blood film|peripheral blood smear]] in COVID 19 patients.
*[[Blood film|Peripheral blood smear]]: May be helpful if there is a suspicion of other causes of [[anemia]].  However, there is insufficient evidence recommending routine [[Blood film|peripheral blood smear]] in COVID 19 patients.
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===Electrocardiogram===
===Electrocardiogram===
There are no [[The electrocardiogram|ECG]] findings associated with COVID-19-associated anemia.
There are no [[The electrocardiogram|ECG]] findings associated with [[COVID-19|COVID-1]]9-associated anemia.


===X-ray===
===X-ray===
There are no [[X-rays|x-ray]] findings associated with COVID-19 associated anemia.
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 findings associated with COVID-19-associated anemia.
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 COVID-19 associated-anemia.
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 COVID-19 associated-anemia.
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 COVID-19 associated-anemia.
There are no other [[imaging]] findings associated with [[COVID-19]] associated-anemia.


===Other Diagnostic Studies===
===Other Diagnostic Studies===


* [[Bone marrow examination]]: May be helpful if there is a suspicion of other causes of [[anemia]]. However, there is insufficient evidence recommending routine bone marrow examination in COVID-19 patients<ref name="pmid28189170" />
* [[Bone marrow examination]]: May be helpful if there is a suspicion of other causes of [[anemia]]. However, there is insufficient evidence recommending routine [[bone marrow examination]] in [[COVID-19]] patients<ref name="pmid28189170" />
* [[Cytogenetics|Cytogenetic]] and [[Molecule|molecular]] tests : May be helpful if there is a suspicion of other causes of [[anemia]]. However, there is insufficient evidence recommending routine cytogenetic and molecular in COVID 19 patients.
* [[Cytogenetics|Cytogenetic]] and [[Molecule|molecular]] tests : May be helpful if there is a suspicion of other causes of [[anemia]]. However, there is insufficient evidence recommending routine [[Cytogenetics|cytogenetic]] and [[Molecule|molecular]] in [[COVID-19]] patients.


==Treatment==
==Treatment==
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===Surgery===
===Surgery===
Surgery is not a treatment option for patients with COVID-19 associated anemia.
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 COVID-19 associated anemia.
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 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>
Minimal amount of blood should be drawn for [[Blood test|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 17:36, 1 July 2020

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List of terms related to COVID-19-associated anemia

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

Classification

Pathophysiology

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

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

History and Symptoms

Physical Examination

Laboratory Findings

  • Compelete blood count (CBC):[4][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).

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

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 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

  1. https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty |title= (help)
  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 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. 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 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. 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. 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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