key: cord-0849529-6k1pbnru
authors: Marhaeni, Wulandewi; Wijaya, Andreas Budi; Khairiyadi; Munawaroh; Hendriyono
title: Coagulation Abnormalities Due to COVID-19 in a Child with Thalassemia
date: 2021-01-08
journal: Indian J Pediatr
DOI: 10.1007/s12098-020-03600-9
sha: 6133d4f2470a34cb003038e6a8661ae9194a6286
doc_id: 849529
cord_uid: 6k1pbnru

nan

To the Editor: Novel coronavirus infection in Indonesia reached 140,000 cases by 17th August 2020. There was inadequate data that supported the involvement of coagulation problems in pediatric cases, especially those with transfusion-dependent-thalassemia.

We presented 4 pediatric cases of COVID-19 (positive oropharyngeal swab) and nonsplenectomized transfusiondependent-thalassemia (beta-thalassemia), which came for blood transfusion visit. Three patients were male and 1 patient was female. The age ranged from 9 y 8-mo-old to 17-y-old. All of our patients were mildly ill; mild respiratory symptoms were reported only in 2 cases; however, three patients showed lung infiltrate in the radiologic examination. None of them presented lymphopenia, thrombocytopenia, elevated CRP, elevated Troponin-T, or bleeding manifestation. The mean hemoglobin level was 6.7 g/dL. Elevated D-dimer was detected in 1 patient. Three thalassemic patients had prolongation of APTT or PT. None of our patients developed clinical thrombosis. The mean ferritin level (2524.42 ng/mL) has been increased from the previous month (980.51-3672.63 ng/ mL). Supportive and therapeutic care such as blood transfusion, antibiotics, antiviral were given. Oral iron chelator has still been given. Fibrinogen level, liver biopsy, and MRI T2* were not performed because of limitations.

Elevated D-dimer and PT prolongation have been reported in adult COVID-19, which might be related to worsening disease processes and poor prognosis [1, 2] . Excessive activation of coagulation cascade will lead to D-dimer elevation and imbalance between procoagulant and anticoagulant homeostatic mechanisms [3] . Coagulation problems in adult thalassemia patients with COVID-19 suggested that it might not be more severe than the general population [4] . Appropriate to the previous study, our patients with thalassemia also showed less severity than the general population, which might suggest partial coagulation problems. The beta-thalassemia population should not have the same risk of COVID-19 as other patients, considering its reduced severity [5] . No recommendation for mildly ill patients to get prophylactic low molecular weight heparin. Dysregulation of the coagulation cascade is prominent findings in SARS-Cov-2 infection associated with transfusion-dependent-thalassemia. A larger sample is required to better understand the impact of coagulation abnormalities due to COVID-19 in beta-thalassemia children.

COVID-19 anticoagulation recommendations in children

COVID-19 associated coagulopathy

Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past

Care of patients with hemoglobin disorders during the COVID-19 pandemic: an overview of recommendations

Thalassemic child presenting with anosmia due to COVID-19

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Conflict of Interest None.