key: cord-0725024-3cuz1893
authors: Sahu, Kamal Kant; George, Laeth; Jones, Nelroy; Mangla, Ankit
title: COVID‐19 in patients with sickle cell disease: A single center experience from Ohio, United States
date: 2021-02-01
journal: J Med Virol
DOI: 10.1002/jmv.26816
sha: c272ffbf6b0951c5ca9cfe87bfba4adf01ef6bbb
doc_id: 725024
cord_uid: 3cuz1893

Coronavirus disease 2019 (COVID-19) pandemic is expanding at an enormous pace and has already affected over 15 million population This article is protected by copyright. All rights reserved.

Coronavirus disease 2019 (COVID-19) pandemic is expanding at an enormous pace and has already affected over 15 million population. 1 Individuals with comorbidities are the worst affected with risk factors like old age, diabetes, chronic airway disease, immunosuppressed, and cancer. 2 Sickle cell disease (SCD) is a common genetic disease and needs special care owing to impaired immunity and compromised cardiopulmonary system.

Hereby, we share our institutional experience with SCD patients during the COVID-19 pandemic In our chart review (approved from the institutional review board), we captured five laboratory-confirmed COVID-19 patients with SCD. Four patients required inpatient treatment, while the other one was managed as an outpatient. The average age of the patients was 32. 6 years (range 21-47 years) with three females and two males. Only two out of five were on chronic therapy with hydroxyurea. Importantly, two out of the five patients presented to us only with generalized body aches.

Three patients had classical imaging findings suggestive of COVID-19 disease. None of the patients required intensive care or mechanical ventilation with only one patient had a new oxygen requirement (Table 1) Table 2 ).

The severe acute respiratory syndrome coronavirus 2 virus can act as a potential trigger to acute chest syndrome (ACS) in SCD patients. Factors, such as hypersplenism, vasculopathy, iron overload, and recurrent veno-occlusive crisis (VOCs) leads to impaired immunity that can lead to more fatal outcome than non-SCD patients in COVID-19 pneumonia. 3 Also, to note that the clinical presentations of COVID-19 related ACS, COVID-19 pneumonia, and bacterial pneumonia can overlap ( Figure 1 ). This could be challenging especially in a scenario when one or more entities co-exist in a same patient. In general, diffuse ground glass appearance in imaging is more commonly seen in COVID-19 pneumonia than ACS or bacterial pneumonia. Other classical findings like hemolysis, rapid falling hemoglobin, bone aches could be more suggestive of ACS than COVID-19 per se.

However, in practical scenario it might be extremely difficult to definitively rule out one possibility over the other.

College of Wisconsin is an excellent platform to collaborate the cases of SCD acquiring COVID-19 and their outcome (https:// covidsicklecell.org/updates-data/). 4 The latest data (updated till

July 17, 2020) shows 260 cases of SCD registered from across the world (mostly from the US) with an average age of 26.83 years, and African American females being the worst affected population. Just like our patient series, the majority of the patients from the registry were on hydroxyurea and without any chronic transfusion therapy. An interesting observation which we also noted in our case series that, 31.15% of patients (81 out of 260) presented with symptoms of pain only. The majority of the patients (54.62%) had mild symptoms with a mortality rate of 6.15%. The second-largest study reported includes a French experience with 83 SCD patients with COVID-19 (multicentric study, 24 hospitals). 5 The French group showed that the prevalence of intensive care admission was more with advanced age (53% in the older group, the median age of 54 years vs. 13% in the younger group, the median age of 28 years). The majority of the patients have associated VOCs (54%, 44 out of 81 patients), followed by ACS (28%, 23 out of 82 patients). 20% of the patients required ICU care which is almost like the results reported by SECURE-SCD global registry (25% were severe or critically ill). In addition to the above-mentioned studies, the other two largest single-center studies reported till now, both from the UK included 10 patients each. 6 

Current perspective on pandemic of COVID-19 in the United States

Clinical features of 69 cases with coronavirus disease

Managing sickle cell patients with COVID-19 infection: the need to pool our collective experience

Early release-coronavirus disease among persons with sickle cell disease

Prognosis of patients with sickle cell disease and COVID-19: a French experience

COVID-19 in patients with sickle cell disease-a case series from a UK Tertiary Hospital

COVID-19 infection and sickle cell disease: a UK centre experience