Hematologic autoimmune manifestation secondary to coronavirus disease 19 infection – a single-center experience

Abstract

BACKGROUND: Since December 2019, multiple human cases of novel coronavirus infection were reported, representing with upper respiratory symptoms (influenza-like presentation). The virus was named the severe acute respiratory system coronavirus 2 (SARS-COV-2). Studies have reported cases of patients with coronavirus disease 19 (COVID-19) infection, including development of several autoimmune events that suggest that infection with SARS-CoV-2 may be associated with initiation of autoimmune hematological autoimmune disorders. AIM: This study aims to review the hematological autoimmune phenomena after infection with SARS-CoV-2 to assist into the pathogenic mechanisms, clinical manifestations, and treatment of this group of patients. MATERIALS AND METHODS: This is a retrospective study that includes 21 patients with autoimmune diseases such as secondary immune thrombocytopenia (ITP), autoimmune hemolytic anemia (AIHA), and thrombotic thrombocytopenic purpura (TTP) that have emerged after COVID-19 infection. The patients were diagnosed and treated at the University Clinic of Hematology-Skopje for a period of time from January 2020 to April 2021. RESULTS: The most common hematologic autoimmune disorder was ITP in 13 cases (62%) followed by AIHA in 5 cases (24%) and TTP in 3 individuals (14%). The mean time of onset of the hematologic autoimmune presentations was 18.4 ± 10.3 days. The therapy of this condition in patients with COVID-19 infection requires an individualized approach to achieve a precise balance between the risk of severe bleeding and of thromboembolic events. CONCLUSION: Causal relationship between COVID-19 infection and these autoimmune events still requires further studies. We should all have in mind the risk of development of hematologic autoimmune disorders in infected patients.