Sickle cell and covid-19:
Patients with sickle cell disease and suspected COVID-19 in a pediatric intensive care unit
Heilbronner, C., Berteloot, L., Tremolieres, P., Dupic, L., de Saint Blanquat, L., Lesage, F., Odièvre, M.‐H., de Marcellus, C., Fourgeaud, J., de Montalembert, M., Grimaud, M., Moulin, F., Renolleau, S., Allali, S. and Oualha, M. (2020), Patients with sickle cell disease and suspected COVID‐19 in a paediatric intensive care unit. Br J Haematol, 190: e21-e24. https://doi.org/10.1111/bjh.16802
I chose to present this research article along side my case presentation of the 5 year old F with a history of sickle cell coming in for abdominal pain. Even though my patient presented with abdominal pain, and was tested negative for COVID via the rapid swab, I thought this was a very unique and interesting case and wanted to look more into the relation and effects of Sickle cell positive patients with suspected COVID.
Patients with COVID are prone to infections and acute chest syndrome. Data regarding acute chest syndrome in sick cell positive adults are plenty, but the effects in pediatrics are lacking. This study is a observational retrospective study , in which all patients with sickle cell and patients suspected of COVID were eligible. From March 1st to April 15th 2020, 12 children between the age of 5-17 with sickle cell were enrolled, and the PCR COVID swab was positive in 4 patients. These patients had symptoms 2-12 days before hospital admission. These patients had chest pain and shoulder pain and needed IV morphine. All 4 patients presented with acute chest syndrome and decreased oxygen level and required Noninvasive Ventilation. After being discharged form PICU, they all had favorable oxygen levels. These patients also showed signs of consolidations and effusions on their imaging, and had high fevers. They were each given cefotaxim and azithromycin. Three of the patients received blood transfusions, and all had a RBC exchange.
Due to sickle cell , a CT may not be reliable in these patients as the SCD can overlap with some of the imaging findings. Also patients with both Sickle cell and COVID have an even greater thrombosis risk. Usually in patients with acute chest syndrome, RBC transfusions are saved for those with extreme severity, however all patients with COVID positive results are receiving transfusions because of how lethal the combination is.
As this is one of the first studies looking at COVID and sickle cell in pediatric patients, more research is needed. However in this study, all patients had electrophoresis, NIV, with supportive treatment, and all had positive successful outcomes.
