Case Report: Management of COVID-19 in a Sickle Cell Anaemia Patient: A Case Report

Introduction

The SARS-CoV-2 virus, which causes COVID-19, has had a major effect on the health care systems around the world.^1,2 Severe cases of the virus can lead to acute respiratory distress syndrome, multiple organ failure, and even death. Long-term health problems and symptoms may also be experienced by survivors of the virus.^3,4 Inherited red blood cell disorder, sickle cell disease (SCD), is characterised by chronic hemolytic anaemia, vascular occlusion, and vital organ deterioration. Childhood vaso-occlusive events can lead to functional asplenia and lifelong susceptibility to serious bacterial infections.⁵ African Americans are the group most commonly impacted by SCD; roughly 1 in 500, have the illness. Severe disorders like acute chest syndrome (ACS) and stroke, as well as both acute and chronic pain, are common indicators of sickle cell disease (SCD).⁵

The case

A 19 years old female from western Sudan is a known case of sickle cell anaemia on folic acid which is not regularly taken by the patient and hydroxyurea which the patient started 4 years ago, the patient came complaining of generalised joint pain, shortness of breath and chest pain.

On examination

The patient looked ill, jaundiced, and Afebrile after getting paracetamol IV and the fever from the day before subsided, she was hemodynamically stable, GCS 15/15, the chest was equally elevated with no added sounds, the stool is soft and red for 2 days with less bowel motion once/2 days, and normal bowel sounds, the patient had adequate urine output and lower limb edema with no joint swelling, blood pressure 107/62 mm Hg, mean arterial pressure 72 mm Hg PR 104 RR 21 RBG 102.5 mg/dL.

The patient was confirmed to have COVID-19 infection through the detection of the virus using Polymerase Chain Reaction (PCR) testing. hemoglobin was 6.8 g/dl RBCs 2.16 10⁶/micL WBCs 22.4 10³/micL, NEUT 75.4%, HCT 18.5% MCV 85.7 pictogram/cell, mhc 31.4 mchc 36.7 g/dl platelet 215/micL urea 8 mg/dl T. protein 6_8g/l, T-bilirubin 2.15 mg/dl, D-bilirubin 0.98 mg/dl, AST 107 IU/l, ALT 30 IU/L, ALP 178 IU/L, CRP 48 mg/L.

Management

Dextrose and Sodium Chloride infusion 125/h, Ceftriaxone 1g BD, warfarin 5 mg PRN, paracetamol 1 g PRN, folic acid O.D., Vitamin C and zink, Levofloxacin 500 mg O. D, enmax PRN, Pantoprazole 40 mg, Nebulised hypertonic saline solution T.D.S., diclofenac sodium 75 mg B.D., Rivaroxaban 15 mg B.D.

She received blood two times through the course of her illness; one of them was on the first day of admission.

Discussion

We describe a 19-year-old female patient with sickle cell anaemia who first complained of chest pain, shortness of breath, and generalised joint pain. A PCR test revealed that the patient tested positive for COVID-19… She had a severe case of sickle cell anaemia and was on folic acid and hydroxyurea, which she was not taking regularly. Examination findings were consistent with sickle cell anaemia complications, including lower limb edema and jaundice. The patient’s laboratory findings revealed anaemia, leukocytosis, and elevated inflammatory markers, including CRP. The patient was treated with a combination of medications, including antibiotics, analgesics, anticoagulants, and nebulised hypertonic saline solution. hypertonic saline solution.

Previous studies have reported that patients with sickle cell anaemia are at increased risk of developing severe respiratory infections, including influenza and pneumonia, due to their impaired immune function and underlying lung pathology.^6,7 Therefore, it is not surprising that sickle cell anaemia patients may be at increased risk of severe COVID-19 infection.

Several studies have also reported that sickle cell anaemia patients with COVID-19 are at increased risk of developing complications, including acute chest syndrome, pulmonary embolism, and multi-organ failure.^8,9 The management of sickle cell anaemia patients with COVID-19 should focus on early detection and treatment of complications, including aggressive management of pain, fluid and electrolyte balance, and oxygenation.^10,11

An important point is that this patient received a blood transfusion early on in her hospitalisation, which may have contributed to her positive outcome. This is consistent with a previous case report that suggested red blood cell exchange transfusion may be beneficial in the early management of sickle cell disease patients with COVID-19. It also suggests taking this intervention into account in order to avoid respiratory distress and the requirement for intubation or admission to an intensive care unit.¹²

This case report offers important details regarding the clinical presentation and treatment of a COVID-19 sickle cell anaemia patient. It emphasises how crucial it is to identify and treat sickle cell anaemia problems in COVID-19 infections as soon as possible in order to enhance patient outcomes. Also, it provides a comprehensive overview of the patient’s examination findings and laboratory investigations, which can aid clinicians in diagnosing and managing sickle cell anaemia patients with COVID-19. patients with COVID-19.

One important limitation of this case report is that it does not provide information on the patient’s baseline sickle cell anaemia status, including the frequency of VOC and ACS episodes, which could impact the patient’s response to COVID-19 infection. Secondly, it does not provide information on the duration of treatment and follow-up of the patient, which could impact the long-term outcomes of the patient. Lastly, this is a single case report, and therefore the findings may not be generalizable to other sickle cell anaemia patients with COVID-19.

In conclusion, sickle cell anaemia patients with COVID-19 may be at increased risk of developing severe complications, and early detection and management of complications are crucial for improving patient outcomes. Further research is needed to determine the optimal management strategies for sickle cell anaemia patients with COVID-19.

Consent

Written informed consent for publication of their clinical details was obtained from the patient.