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:
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 [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][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 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).[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 [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 anemia in COVID-19 infection.
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with anemia in COVID-19 infection.
CT scan
There are no CT scan findings associated with anemia in COVID-19 infection.
MRI
There are no MRI findings associated with anemia in COVID-19 infection.
Other Imaging Findings
There are no other imaging findings associated with anemia in COVID-19 infection.
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
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 anemia in COVID-19 infection.
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 anemia in COVID-19 infection.[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 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).