NYMC Faculty Publications

Coombs-Negative Hemolytic Anemia in an Elderly COVID-19 Patient

Author Type(s)

Resident/Fellow, Faculty

DOI

10.7759/cureus.58589

Journal Title

Cureus

First Page

58589

Last Page

58589

Document Type

Case Report

Publication Date

4-19-2024

Department

Medicine

Keywords

covid-19; hematology; cd147; coombs negative; elderly population; non-immune hemolytic anemia

Disciplines

Medicine and Health Sciences

Abstract

COVID-19 infections are known to cause multi-organ complications. Hematological complications like autoimmune hemolytic anemia with a positive direct antiglobulin test (DAT), are commonly encountered. However, Coombs-negative hemolytic anemia is extremely rare. We report an interesting case of an elderly female with moderate-severe acute respiratory distress syndrome in the setting of COVID-19 pneumonia-causing Coombs-negative hemolytic anemia. This patient initially presented with sudden onset abdominal pain and vomiting, found to have an incarcerated inguinal hernia with small bowel obstruction (SBO) on imaging. Additionally, labs revealed positive COVID-19 antigen test and normocytic anemia. The hospital course was complicated by worsening hemolytic anemia and thrombocytopenia requiring blood products. Extensive workup for hemolysis in this patient with no prior hematological abnormalities, was negative for DAT and other conditions associated with or causative of hemolysis. At discharge, hemolytic parameters improved and on follow-up, hemoglobin returned to baseline, and repeat hemolytic parameters were normal. This case emphasizes the importance of considering SARS-CoV-2 along with other viral infections as one of the differentials for Coombs-negative hemolytic anemia.

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