Coagulation Abnormalities Due to COVID-19 in a Child with Thalassemia

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 transfusion-dependent-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.

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