Patients with blood transfusion-dependent thalassemia were not at increased risk for excess morbidity or mortality from COVID-19, according to the results of a small retrospective study published in the Pediatric Hematology and Oncology Journal.
Although it has been hypothesized that patients with thalassemia are at lower risk of developing COVID-19, studies from across the world have documented that patients with thalassemia are at an increased risk of COVID-19-related mortality.
“We share our experience of managing patients with transfusion-dependent thalassemia with SARS-CoV-2 in a resource-limited setting,” the authors wrote in their report.
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The retrospective study evaluated data from 250 patients with thalassemia from a thalassemia center at a tertiary care facility in India. Patients were confirmed positive for SARS-CoV-2 infection by reverse transcriptase polymerase chain reaction (RT-PCR), which was conducted at hospital screening if the patient had symptoms or a known exposure. Demographics, clinical characteristics, and disease outcomes were collected from medical records.
Mild COVID-19 cases were managed at home and followed by a dedicated nurse with daily temperature and oxygen saturation measurements until fever resolved. Patients received zinc, multivitamins, and ivermectin/doxycycline. Patients with moderate to severe COVID-19 were admitted to the hospital and were treated with steroids. Blood transfusions resumed when patients tested negative by RT-PCR or had isolated for 10 to 14 days after the day of the previous positive test.
There were 14 (0.06%) patients diagnosed with SARS-CoV-2 infection with a mean age of 18.9 and body mass index of 18.5 kg/m2. Of the 14 patients, symptoms promoted testing for 8 patients, 4 were tested due to a known exposure, and 2 tested positive during routine management for non-thalassemia-related hospitalization.
The most common SARS-CoV-2 related symptoms were fever and fatigue, with other symptoms including headache, sore throat, loss of taste and smell, and vomiting. Shortness of breath was reported by 1 patient managed at home, who simultaneously reported desaturation on room air.
Hospitalization was required for 2 patients, including a patient with severe cardiac iron overload and diabetes mellitus and another with desaturation on room air. There was a total of 4 patients who experienced exacerbation of anemia and required blood transfusion.
The authors concluded that, “the underlying diagnosis of transfusion-dependent thalassemia did not lead to excess morbidity and mortality in our cohort.” They added “our ability to manage patients at home helped in better utilization of resources.”
Reference
Kakkar S, Anand V, Kapoor R, et al. Home isolation in transfusion-dependent thalassemia patients with SARS CoV2 infection: Experience from a developing country. Ped Hematol Oncol J. Published online April 19, 2022. doi: 10.1016/j.phoj.2022.04.024
