COVID-19 Reinfection Reported in Patient with Beta Thalassemia

The first case report of coronavirus 2019 (COVID-19) reinfection in a patient with beta thalassemia major describes a positive PCR positive test for SARS-CoV-2 without corresponding symptoms 55 days after an initial positive test and hospitalization for a reportedly "smooth" course of COVID-19.

The second test was performed as routine screening prior to admission to hematology for follow-up and routine blood transfusion. There was no additional testing after the second positive test, however, to investigate the possibility of a false result.

Lina Okar, MD, Hamad Medical Corporation in Qatar, and colleagues reported that the 31-year-old woman with transfusion dependent beta thalassemia major and previous splenectomy was also receiving iron chelation therapy as well as medications for type 2 diabetes and hypothyroidism.

"It is worthy to notice that even with reinfection, in our case the episode was smooth and detected with routine screening without even any respiratory symptoms during the whole quarantine period," Okar and colleagues wrote. "However, the patient has multiple comorbidities, splenectomized, iron overload, which might put her at increased risk for reinfection yet not for complications."

Okar and colleagues cited the Thalassemia International Federation (TIF) statement on the challenges of providing care to patients with hemoglobinopathies during the pandemic. They noted that although hemoglobin disorders have not been directly linked to respiratory conditions, close monitoring of thalassemia patients is warranted as they are at risk for multi-organ damage and complications of COVID-19.

A recent review of the potential susceptibility of patients with thalassemia to the complications of COVID-19 considered several risk factors. including iron overload and oxidative stress, iron chelation and splenectomy, chronic liver disease, cardiac complications, diabetes and adrenal insufficiency and abnormal immune response.

In their review, Mehran Karimi, MD, Hematology Research Center, Shiraz University of Medical Sciences in Iran and Vincenzo De Sanctis, MD, Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital in Italy, observed that there has been extensive notice of heightened risk of COVID-19 complications in patients that have such comorbidities as cardiovascular disease, lung disease, diabetes and cancer.

"However, relatively few patients were included in the recent studies, which makes (it) particularly difficult to distinguish a clear link between comorbidity and disease severity," they indicate.

Splenectomy has been correlated with quantitative lymphocyte changes and aggravation of the immunological effects of multiple transfusions, due to reduced clearance of immune cells, Karimi and De Sanctis noted.

The reviewers suggested that, although there is no evidence linking iron chelation and susceptibilty to SARS-CoV-2 infection, patients with thalassemia who become positive for COVID-19 and develop symptoms should discontinue the iron chelation.

The patient in the reported case received medication for type 2 diabetes, and Karimi and De Sanctis point out that diabetic patients have impaired immune response to infection; and that poor glycemic control "impairs several aspects of the immune response to viral infection and also to the potential bacterial secondary infection in the lungs."

Okar and colleagues conclude the case report with the caution that patients with hemoglobinopathies are among the groups vulnerable to COVID-19 complications and "need extra precaution during their recurrent visits to the health care facilities."

The case report, “COVID-19 Reinfection in Beta-Thalasemia Major Patient: First Case Report,” was published as a preprint in Authroea.

The review, “Implications of SARSr-CoV 2 Infection in Thalassemias: Do Patients Fall into the "High Clinical Risk" category?” was published in Acta Biomedica.