key: cord-0844068-l78hi9jz
authors: Bou‐Fakhredin, Rayan; Daadaa, Hisham; Koussa, Suzanne; Abou Nasr, Therese; Noun, Peter; Taher, Ali T.
title: SARS‐CoV‐2 infection in patients with β‐thalassemia: Experience from Lebanon
date: 2021-05-13
journal: Am J Hematol
DOI: 10.1002/ajh.26211
sha: 367ac4e72368ad113512dc077016e7b5b423446e
doc_id: 844068
cord_uid: l78hi9jz

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remains crucial for the timely management of patients. In this report, we investigate the severity of Covid-19 among β-thalassemia patients who are regularly followed up at the Chronic Care Center (CCC), a tertiary care thalassemia center in Lebanon.

Throughtout the Covid-19 pandemic which began in Lebanon in February, 2020 and up until April, 2021, 40 cases of β-thalassemia and Covid-19 were reported by CCC, and after patients informed the center of a confirmed diagnosis by real time-polymerase chain reaction (RT-PCR). Patients' clinical characteristics, Covid-19 signs and symptoms, treatment, disease course and outcomes were collected by analyzing patients' medical records and by directly calling the patients and checking on their well-being ( The comorbidities present among our β-thalassemia patients are reported in the Table S1 . Overall, 37 (92.5%) patients had at least one comorbidity. Most of our patients suffered from iron overload. Liver iron concentration (LIC) (mg/g) was classified as: mild (LIC 3-7 mg/g), moderate (LIC >7-14 mg/g), and severe overload (LIC >15 mg/g). In our patient cohort 13 (32.5%) patients had mild iron overload, seven (20.6%) patients had moderate iron overload, and six (17.6%) patients had severe iron overload. Eight patients never had their LIC determined. Twenty six patients (65%) were splenectomized. Of the 26 splenectomized patients, 19/26 (73.1%) were on aspirin, 1/26 (3.8%) was on warfarin for his co-existing atrial fibrillation, and 3/26 (11.5%) were switched to low molecular weight heparin (enoxaparin) in the hospital setting. Among our cohort of 40 patients, 35 (87.5%) were on iron chelation therapy. According to a set of recommendations by the American Society of Hematology, if a thalassemia patient is exposed to SARS-CoV-2 but is asymptomatic there is no reason to interrupt iron chelation. If a patient becomes symptomatic, especially in the case of moderate and severe disease, then interruption of iron chelation is advisable. 9 In our group of patients, mild to moderate disease was treated similar to asymptomatic, thus patients continued iron chelation therapy. However, iron chelation therapy was interrupted in all patients with severe disease and who were admitted to the hospital until resolution of symptoms or until a confirmatory negative PCR.

In terms of signs and symptoms, four patients (10%) were asymptomatic. The remaining 36 (90.0%) patients had signs and symptoms, most notably in the form of fatigue, fever, ageusia, and anosmia (Table S1 ). Four (10%) patients were hospitalized, but none required 

The dataset used and analyzed during the current study are available from the corresponding author on reasonable request.

Rayan Bou-Fakhredin 1 , Hisham Daadaa 1 , Suzanne Koussa 2 , Therese Abou Nasr 2 , Peter Noun 3 , Ali T. Taher 1   1 

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